title: Renal failure and specialist palliative care: an assessment of current referral practice.
abstract: OBJECTIVE
  This retrospective audit assessed the referral practice for patients with end-stage renal failure from the nephrology service to the specialist palliative care team in a large teaching hospital in the north-west of England.
  
  
  METHODS
  Forty-nine referrals with 'renal' as a primary diagnosis over a two-year period were identified from referral data. General and palliative care notes were reviewed and a data collection tool was designed.
  
  
  RESULTS
  Most common reasons for referral were for 'placement' (38.6%) and 'dying/distressed' patients (22.7%), although psychological support was also prevalent (15.9%). Renal teams discussed stopping dialysis in the majority of cases (89%), but documented preferred place of care less frequently (48.3%) and achieved discharge to these locations in less than half of cases (21.4%).
  
  
  CONCLUSIONS
  There was well-established referral practice between the renal and the specialist palliative care team at the hospital examined. The renal team appropriately referred for symptom control and support in the dying phase of patients. There are issues surrounding placement and increased implementation of end-of-life care tools, including the Liverpool Care Pathway, Gold Standards Framework and Preferred Place of Care documentation for renal patients, which needs to be an ongoing priority.
authors.affiliation: Nephrology, Marie Curie Palliative Care Institute, Liverpool, UK. amckeown@nhs.net
authors.forename: Alistair
authors.initials: A
authors.lastname: McKeown
authors.forename: Ruth
authors.initials: R
authors.lastname: Agar
authors.forename: Maureen
authors.initials: M
authors.lastname: Gambles
authors.forename: John E
authors.initials: JE
authors.lastname: Ellershaw
authors.forename: Heino
authors.initials: H
authors.lastname: Hugel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D051437:Renal Insufficiency / Q000451:nursing*; D012189:Retrospective Studies