Lihini is a Basic Physician Trainee at St Vincent's Hospital, Melbourne. She aspires to specialise in Palliative Care and Elderly Care Medicine in the future. In addition, she has a keen interest in Global Health.
Recognising and Responding to Dying in Hospital Under General Medical Teams
Aims: To understand the trajectory of care for general medical patients who die in hospital, particularly with regards to discussing goals of care and recognising dying.
Methods: A retrospective cohort study was performed on 135 patients admitted under General Medicine who died at St Vincent’s Hospital, Melbourne between January 1st and December 31st 2018 using a validated end-of-life care quality tool.
Results: Of 135 patients, 59% were male. Average age at death was 78.3 years and average Charlson comorbidity index was 2.7. The average length of stay was 7.8 days. Most (87%) patients had at least one Acute Resuscitation Plan (ARP) usually completed on the day of presentation (median 0, IQR [0,0]). Of this group, 62 (50.4%) had their ARP changed at least once, median 1 day prior to death, IQR [1,2.0]. Most (91%) patients had at least one goals of care (GOC) discussion, with median time from GOC discussion with patient/family and death being 2 days, IQR [1,5]. Median time from documenting dying to death was only 1 day, IQR [0,6].
Conclusions: GOC discussions occur late in the admission and close to death, suggesting that recognising the potential for dying and responding to this is challenging. Documented dying and altered ARPs occur only just prior to death, suggesting that there is discomfort with transitioning from active to end of life care, despite the recognition of imminent death. This study reveals opportunities to improve comfort with recognition of and communication about the potential for dying with patients, families and care teams, with the hope of an early focus on palliative and end of life care for dying patients.