Palliative and end of life care on the Acute Medical Unit

Abstract

Introduction: Early and appropriate recognition of patients requiring palliative care is essential to delivering high quality management and Acute Medical Units have a pivotal role to play in ensuring its implementation. Aim: To identify the prevalence of patients admitted to Acute Medical Unit (AMU) who met palliative criteria, the overall prevalence of terminal diagnoses and the frequency of appropriate referrals to the units Palliative Care in reach team. Methods: An audit was performed at a University Hospital AMU to examine these issues. The NHS Supportive and Palliative Care Tool (SPCIT) was used to identify palliative patients. 409 patients were admitted to the AMU during the study period. Results: 66 (16.1%) of patients were identified as palliative. Two-thirds of these patients had a non-malignant diagnosis. 30% of palliative patients were referred to the palliative care team of which 85.4% had a diagnosis of cancer. 88% of patients that received ongoing palliative care review had a diagnosis of cancer. Conclusion: There is a high prevalence of patients with a terminal diagnosis presenting to the AMU reflecting an aging population and increasingly complex co-morbidities. Palliative patients with a non-cancer diagnosis are less likely to be referred to the palliative care team, which has the potential to disadvantage their care.