1. MORTALITY AUDIT Dr S Callin SpR Palliative Medicine Dr L Russon Consultant Palliative Medicine BRI Palliative Care Team

2. Background Sunday Times league table – hospitals judged by death rates Mortality group (BRI): Why are patients dying in hospital? Why are patients with terminal illnesses dying in hospital?  Are we planning appropriately for dying patients? Preferred place of care

3. Aims of the audit Identify reasons why patients with terminal illnesses die in hospital Improve system to reduce numbers of patients with terminal illnesses dying inappropriately in hospital

4. Methods Patient sample: patients referred to the hospital palliative care team oncology ward Haematology ward 3/12 audit of all deaths Retrospective review of the notes within one week of death Interview with a member of the treating team within one week of death

5. Data Collection Duration of admission Palliative Care Team involvement Liverpool Care Pathway for the Dying Preferred place of care Reason for death Unexpected death Deterioration before able to plan discharge Deterioration before planned discharge Clearly stated wish to remain in hospital Awaiting hospice bed Other

6. Results 54 deaths 22 oncology 9 haematology 23 other wards 57% female Median age 72 (Range 34-91) 6% non malignant

7. Results Duration of admission Median 12 days (range 1-59) PCT involvement 56% of all deaths audited oncology ward (6/22) haematology ward (1/9) Duration of PCT involvement Median 7 days (0-30)

8. Results

9. Most common reason for death in hospital: ‘deterioration before able to plan discharge’ (n=32) But 13/32 patients had been in hospital for more than two weeks 1 patient was an inpatient for 30 days, 1 for 50 days and 1 for 51 days

10. Liverpool Care Pathway (LCP) 37% of all deaths audited on the LCP oncology deaths (14/22) haematology deaths (3/9) other wards (3/23) 0% non malignant cases 13/32 patients where deterioration was perceived to be before able to plan discharge were on the LCP

11. Preferred place of care Documented preferred place of care Not documented 37 Hospital 4 Home/hospice 13

12. Conclusions Almost 2/3 of cancer patients/patients referred to the PCT died in hospital because the treating team perceived they deteriorated before able to plan discharge But over 1/3 of those patients were in hospital for >2weeks Is the dying phase being recognised early enough? … and over 1/3 were on the LCP Should preferred place of care be explored earlier with patients?

13. Conclusions Need to be more proactive in diagnosing and planning care for terminally ill patients

14. What happened next..............?