title: Care of the dying in Australia's busiest hospital: benefits of palliative care consultation and methods to enhance access.
abstract: BACKGROUND
  Hospital-based palliative care consultative teams assist with decision-making, symptom management, patient and family support, and discharge planning for those with advanced illness. However, there is evidence to suggest that many patients dying within acute hospitals receive no specialist palliative care input. This project aimed to assess care provided to patients dying within a large Australian hospital and to understand senior clinician decision-making around referral to palliative care.
  
  
  METHODS
  A multi-methods approach was taken that incorporated a literature review, a retrospective chart-audit using the Liverpool Care Pathway to assess quality of end-of-life care, and semistructured interviews with clinicians.
  
  
  RESULTS
  The audit demonstrated wide variation in referral practices from clinical units, with overall only 42% of dying patients referred. A number of deficiencies in the care of dying patients within the hospital were evident; however, referral for palliative care consultation was associated with improvements in availability of appropriate end-of-life medication orders, communication with patients and families, and cessation of futile treatment and interventions. Eight themes emerged from the interviews with clinicians, including uncertainty as to the role of palliative care and a discrepancy between medical and nursing views of the utility and timing for palliative care.
  
  
  CONCLUSIONS
  The findings demonstrate both the need for more frequent and/or earlier referral of dying patients and the need for generalist staff to become more skilled in the delivery of palliative care. It also highlights the need for palliative care clinicians to be educators and advocates within services to enhance care at end-of-life.
authors.affiliation: Department of Palliative Care, Royal Melbourne Hospital, Parkville, Victoria, Australia. brian.le@mh.org.au
authors.forename: Brian Huong Canh
authors.initials: BH
authors.lastname: Le
authors.forename: James Nicholas
authors.initials: JN
authors.lastname: Watt
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006757:Hospital Units; D006801:Humans; D008297:Male; D008485:Medical Audit; D008505:Medical Staff, Hospital; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D014739:Victoria