MORTALITY AUDIT

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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

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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

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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

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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

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Results

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

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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)

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Results
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Results

• Most common reason for death in hospital
  deterioration before able to plan discharge
  (n32)
• 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

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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

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Preferred place of care

• Documented preferred place of care
• Not documented 37
• Hospital 4
• Home/hospice 13

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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 gt2weeks
• 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?

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Conclusions

• Need to be more proactive in diagnosing and
  planning care for terminally ill patients

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