Rapid death after admission to palliative care

St Vincent's Hospital Melbourne. Melbourne Medical School, University of Melbourne.
Internal Medicine Journal (Impact Factor: 1.64). 04/2012; 42(9). DOI: 10.1111/j.1445-5994.2012.02790.x
Source: PubMed


Background:  Palliative care units provide non-curative treatment and support to patients with terminal illness. Brief end-of-life admissions are disruptive for patients and their families, and increase staff stress. Extremely rapid deaths (survival <24 hours from admission) are particularly challenging for all involved. From 1(st) January 2010 to 23(rd) August 2011, 256 patients died on the Palliative Care Unit (Caritas Christi) at St Vincent's Hospital Melbourne. Forty-two died within 24 hours (16%), while 214 survived beyond 24 hours (84%). Aims:  A retrospective chart audit was conducted, aiming to identify factors characterizing those patients who died within 24 hours. Methods:  Groups were compared for age, gender, country of birth, preferred language, ward of origin, primary pathology, time trends, whether an emergency code was called, Palliative Care Outcomes Collaboration (PCOC) phase, modified Karnofsky score, and commencement of a syringe driver for medication. Results:  Results showed that admission from neurosurgery (p=0.0001), a vascular or infective pathology (p=0.0001), PCOC phase ≥3 (p=0.0001), modified Karnofsky score ≤20% (p=0.0001) and commencement of a syringe driver prior to or at admission (p=0.0001) were all significantly associated with death within 24 hours of admission. On binary logistic regression, the only independent predictor of patients likely to die in <24 hours from admission was PCOC phase ≥3 (p=0.002). Conclusions:  This study is designed to help clinicians identify patients likely to deteriorate rapidly. Alternative options could include earlier transfer to the palliative care unit, or palliation on their home ward with palliative care consultation.

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