Extra supports would allow more to die at home

ONE-FIFTH OF seriously ill hospital patients could have died at home if sufficient supports were available, an audit of end-of-life care in hospitals has found.

The report by the Irish Hospice Foundation found significant differences in how doctors, nurses and relatives assess the care and quality of death of patients, with doctors tending to underestimate the negative aspects of care and relatives tending to overestimate them.

Hospital admissions through AE departments negatively affect care outcomes at the end of life, the national audit launched yesterday also found.

Four quality standards aimed at improving end-of-life care were launched yesterday by Minister for Health Mary Harney.

These require hospitals to make end-of-life care central to their missions, and to provide training for staff, high-quality care for patients and compassionate support for families.

Responding to a recommendation that dying patients be assured of a single room, Ms Harney promised that the upgrading of palliative care facilities in hospitals would be a priority as facilities were renovated. “We have to ensure that patients have the privacy they are entitled to expect in a decent, civilised society.”

With almost half of all people dying in hospitals, chief executives of hospitals needed to take the issue more seriously, she said. In the late 19th century, 85 per cent of people died at home.

The audit of 43 acute and community hospitals identified 18 separate factors which could help to improve end-of-life care.

These include adequate staffing levels, team meetings between doctors and nurses, training for nurses in palliative care and the addition of end-of-live objectives in hospital plans.

Improved results can also be achieved if nurses are experienced, feel prepared for the death of a patient and there is quality discussion with patients and relatives, the audit states.

The quality of patient documentation is criticised as uneven, while the quality of information given to relatives about end-of-life care in hospitals is described as poor.

The report says doctors and nurses are reluctant to make decisions to stop invasive treatments when patients are dying.

It identifies a hierarchy in the quality of dying in Irish hospitals based on a patient’s disease, with the best treatment accorded to people with cancer and the worst in the case of dementia/frailty.

Among those welcoming the new standards was President Mary McAleese, who said that they would apply to all of us as citizens and patients or providers.