title: Advance care planning and end-of-life care in a network of rural Western Australian hospitals.
abstract: OBJECTIVE
  To provide a current perspective on end-of-life (EOL) care in regional Western Australia, with a particular focus on the final admission prior to death and the presence of documented advance care planning (ACP).
  
  
  METHODS
  Retrospective medical notes audit.
  
  
  METHODS
  One regional hospital (including colocated hospice) and four small rural hospitals in the Great Southern region of Western Australia.
  
  
  METHODS
  Ninety recently deceased patients, who died in hospitals in the region. Fifty consecutive patients from the regional hospital and 10 consecutive patients from each of the four rural hospitals were included in the audit.
  
  
  METHODS
  A retrospective medical notes audit was undertaken.
  
  
  METHODS
  A 94-item audit tool assessed patient demographics, primary diagnosis, family support, status on admission and presence of documented ACP. Detailed items described the clinical care delivered during the final admission, including communication with family, referral to palliative care, transfers, medical investigations, medical treatments and use of EOL care pathways.
  
  
  RESULTS
  Fifty-two per cent were women; median age was 82 years old. Forty per cent died of malignancy. Median length of stay was 7 days. Thirty-nine per cent had formal or informal ACP documented. Rural hospitals performed comparably with the regional hospital on all measures.
  
  
  CONCLUSIONS
  This study provides benchmarking information that can assist other rural hospitals and suggests ongoing work on optimal methods of measuring quality in EOL care.
authors.affiliation: Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Auret
authors.affiliation: Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia.
authors.forename: Craig
authors.initials: C
authors.lastname: Sinclair
authors.affiliation: Albany Community Hospice, Albany, Western Australia, Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Averill
authors.affiliation: Rural Clinical School of Western Australia, University of Western Australia, Albany, Western Australia, Australia.
authors.forename: Sharon
authors.initials: S
authors.lastname: Evans
mesh_terms: D032722:Advance Care Planning / Q000592:standards / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D003142:Communication; D005260:Female; D006780:Hospitals, Rural / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit / Q000592:standards / Q000706:statistics & numerical data*; D010166:Palliative Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D011368:Professional-Family Relations; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000592:standards / Q000706:statistics & numerical data; D013727:Terminal Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data*; D014904:Western Australia
keywords: advance care planning; palliative care; regional health planning; rural health services delivery; terminal care