title: Achieving the preferred place of care for hospitalized patients at the end of life.
abstract: BACKGROUND
  The Department of Health end-of-life strategy contains a number of quality markers which include taking into account patients' wishes for their final place of care. There is a wide variation in how this information is recorded.
  
  
  METHODS
  An audit was conducted on discussion of preferred place of care (PPC) for all patients referred to the hospital palliative care team who died during the audit period. Barriers to achieving PPC and the efficacy of a fast track discharge service were also monitored. The audit was first done in 2007 and was repeated in 2009.
  
  
  RESULTS
  There was an increase in recording PPC. Overall PPC wishes were ascertained for 87% of the patients seen by the team. The PPC was achieved in 76% of cases. The number of patients wishing to die in hospital significantly increased over the audit cycle (from 10% to 30%). Approximately one-third of patients changed their minds regarding PPC.
  
  
  CONCLUSIONS
  The data highlights the need to distinguish between preferred place of care and preferred place of death. Patients' wishes regarding PPC change as death approaches. A greater number of patients wished to die in hospital than was expected.
authors.affiliation: CNS in Palliative Care, 2nd floor Clare House, St George's Healthcare NHS Trust, London, UK.
authors.forename: Ruth
authors.initials: R
authors.lastname: Gerrard
authors.forename: Janet
authors.initials: J
authors.lastname: Campbell
authors.forename: Ollie
authors.initials: O
authors.lastname: Minton
authors.forename: Berit
authors.initials: B
authors.lastname: Moback
authors.forename: Charles
authors.initials: C
authors.lastname: Skinner
authors.forename: Catherine
authors.initials: C
authors.lastname: McGowan
authors.forename: Patrick Charles
authors.initials: PC
authors.lastname: Stone
mesh_terms: D000368:Aged; D005260:Female; D006302:Health Services Research / Q000379:methods; D006738:Hospices / Q000706:statistics & numerical data; D006760:Hospitalization; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008131:London; D008297:Male; D008485:Medical Audit; D009735:Nursing Homes / Q000706:statistics & numerical data; D057240:Patient Preference; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods / Q000592:standards*