114 Approaching the end of life: are referrals to hospital specialist palliative care team arriving too late?

Abstract

Introduction Late referrals to specialist palliative care teams (SPCT) limit the ability of and time for SPCTs to improve symptoms and reduce distress for patients and their families. We aimed to identify all patients referred to the hospital SPCT who died before being seen during 2018 to: Assess if uncontrolled symptoms were present Ensure SPCT responded rapidly Identify ways to support wards with timely referrals and reduce late referrals. Methods Design: Audit with case-notes review Part 1: we identified all hospital patients referred to SPCT who died before being seen, and assessed the hospitals/wards/patient characteristics to identify patterns. We reviewed referral time and our response times/telephone advice. Part 2: Detailed case-notes review of 15% (randomly selected) patients who died before being seen by the SPCT to assess recognition of dying, see if these dying patients had specialist palliative care needs and if symptoms/distress were controlled or not. Results Part 1: In 2018, the SPCT reviewed 1520 patients across the acute trust. 87 (5.6%) patients died before being seen by the SPCT. Of those, 19 patients (21%) were referred and died outside SPCT working hours. Referrals came from 25 different wards. 42 (37%) patients died within 6 hours of referral. Telephone advice was given to healthcare professionals for 37 patients (42%). Most patients were over 65 years old; the common causes of death were pneumonia and cancer. Part 2: 15 case-notes had a detailed review. Median length of stay was 9 days (range 2–40days). Most patients were documented as dying only in the last 2 days. 5 patients had no SPC needs whilst 10 patients had uncontrolled symptoms. Conclusion Promoting earlier recognition of dying and a more integrated approach of palliative care alongside active interventions could optimise symptom management and reduce distress towards end of life for patients dying in hospitals.