Hospitals do not always recognise the enormous significance of their role for society as a whole in relation to dying, death and bereavement. Notwithstanding the fact that most people die outside the home in a hospital or similar setting, many hospitals do not regard end-of-life care as a core activity. The National Audit of End-of-Life Care in Hospitals reveals that only nine of the 24 acute hospitals (38%) and only six of the 19 community hospitals (32%) had a business plan in 2008 which included specific objectives and targets for improving end-of-life care. This contrasts with the situation in Northern Ireland, where an audit of end-of-life care in hospitals and hospices revealed that the infrastructure of policies, procedures and guidelines for end-of-life care is considerably more developed compared to the Republic of Ireland. Two aspects of hospital governance have a significant impact on care outcomes. The first is having end-of-life care objectives in the hospital’s business plan, whilst the second is having sufficient ward staff.
The National Audit shows that hospitals which have end-of-life objectives in their service or business plans have better care outcomes. Specifically, the score for symptom management, as assessed by doctors, is 4.89 percentage points higher in hospitals which have end-of-life objectives in their service plan. This may be due to the fact that hospitals develop this aspect of their service plans when they have doctors who are more attuned to end-of-life issues. Equally, there may be an influence in the opposite direction, with the service plan raising awareness among doctors about the importance of symptom management at the end of life. It is also possible that other variables associated with the service plan may be at work, including organisational features and practices. This is an important result, because it shows the influence that hospital leadership can (at least potentially) exercise on end-of-life care.
Planning & Coordination of end-of-life care issues cannot be tackled by hospitals alone. The large number of unplanned admissions of older people, who will spend the last weeks of their lives in acute hospitals, requires a ‘whole systems’ approach involving primary care, family and community supports, community hospitals, nursing homes, and a health management infrastructure that is responsive to ‘lives as lived’ and not simply to performance metrics.
Learn more about:
Development Plans for End-of-Life Care »
Standing Committees on Dying, Death & Bereavement »
Advance Care Planning »
Integrated Care Framework & Pathways »
View excerpts from ‘Journeys to the End of Life’ (DVD on championing change in end-of-life care) »