Is today a good day to die?

Abstract

Background: Acute hospitals provide end-of-life care to the majority of people who die in Australia. Decisions about whether it is appropriate to escalate life-sustaining measures in patients with chronic, life-limiting illness are often postponed until there is a sudden deterioration. Then, families and health care workers are often required to make medical decisions without knowing the patient’s preferences. Ballarat Health Services is a regional public health service providing acute, subacute, aged residential and community services. It was recognised that while the health service had implemented a range of end-of-life care elements, this was not comprehensive or integrated. Aim: To develop an integrated, systematic approach to delivering best-practice end-of-life care. Methods: A multidisciplinary project steering group was established with key executives participating. Ethics approval was granted and this enabled key stakeholder consultation using focus groups and semi-structured interviews to establish attitudes to end of life care and death. Medical record and mortality review informed the establishment of outcome measures. Results: A framework has been developed to integrate the end-of-life care elements of: advance care planning, identifying patients at risk of deteriorating or dying, medical goals of care documentation, a Care of the Dying Management Plan and explicit communication skills training.