Article Text

Download PDFPDF

66 Assessing the quality of end of life care in patients dying in an acute hospital in London and the impact of the Covid-19 pandemic
  1. Samuel Somers Heslam and
  2. Joanna Davies
  1. Royal Surrey County Hospital, St George’s NHS Foundation Trust


Background This audit measures the extent to which in hospital end of life care is meeting the Five Priorities of Care for the Dying Person. 1) Recognise 2) Communicate 3) Involve 4) Support 5) Plan & Do.


  1. To assess the impact of the Covid–19 pandemic on end of life care.

  2. To provide trust wide feedback in preparation for increasing rates of Covid–19.

Methods Cases were audited retrospectively using quality measures based on the 2016 National End of Life Care Audit. Thirty deaths from November/December 2019 were compared with forty deaths from April 2020 (first peak of Covid-19)

Results Median age was similar pre and during pandemic (81.5 vs 80.3). During the pandemic 70% of patients audited tested positive for covid 19. Pre pandemic 13% of patients died without a Treatment Escalation Plan (TEP) compared to 2% during the pandemic. Pre pandemic 27% of patients received active treatment in the last days of life compared 48% during the pandemic. Involvement of the patient and next of (NOK) in decisions remained >90% pre and during pandemic. During the pandemic spiritual/cultural needs assessments fell by 25% and discussions around place of death fell by 36%.

Conclusions The increased likelihood of active treatment in the last days of life during the pandemic may reflect the rapid disease trajectory of covid-19. The consistent high level of communication with patients and NOKs reflects efforts to communicate via telephone due to visiting restrictions. TEP completion improved during the pandemic in keeping with national drives to establish ceilings of care and the transfer to electronic TEPs in the Trust during the pandemic. Prioritisation of communication and medical intervention during the pandemic may have adversely impacted holistic needs assessment. Learning points from this audit have been publicised in the Trust in preparation for the second wave of the pandemic.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.