The acute health service’s policies make it clear that:
- recognising clinical deterioration - where dying is possible, probable, or imminent - is essential for end of life care
- care of the dying is urgent care.
The acute health service aims to identify patients at two critical points:
- when a patient is likely to die within the next 12 months, but episodes of acute clinical deterioration may be reversible
- when a patient is likely to die in the short term (within days to weeks) and clinical deterioration is probably irreversible.
Use the ‘surprise’ question:
- Would you be surprised if the patient died in the next 12 months? If you would not be surprised, proactively address goals of care, limitations of medical treatment (resuscitation plan) and advance care planning
- Would you be surprised if the patient died during this admission, or in the next days or weeks? If you would not be surprised, as a matter of urgency, review goals of care, limitations of medical treatment (resuscitation plan) and advance care planning.
Triggers for recognition of patients who would benefit from end of life care
- Diagnosis of life-limiting conditions
- Poor or incomplete response to medical treatment, continued deterioration despite medical treatment, or development of new clinical problems during inpatient admission
- Difficult symptoms
- Repeated calls to the rapid response team, particularly if the patient has been admitted for more than one week
- Advanced age with increased frailty, reduced mobility and increased dependence on others to assist with activities of daily living
- Moderate to severe dementia
- Multisystem comorbidities
- Maximal medical therapies already in place
- Decline in the patient’s condition, or a clinical determination that they would not benefit from interventions such as surgery, dialysis or intensive care
- Multiple recent admissions to hospital for exacerbation of a chronic condition
- Unexpected or prolonged stays in hospital
- Tools for condition-specific prognostic prediction7.
See Recognising the last 12 months of life
See Therapeutic Guidelines Palliative Care 2016 Version 4 on the Clinicians Health Channel at your health service
7 For example, the Child-Pugh score for the prognosis of chronic liver disease
See Therapeutic Guidelines in Palliative Care 2016 version 4 on the Clinicians' Health Channel at your health service.