Background or Introduction The rise of COVID-19 and subsequent decline in hospital visitation placed increased importance on the quality of communication between healthcare professionals and the next-of-kin at the end of life. Despite this, the general public perceived that sometimes information about their relative was not adequately communicated, and that there was a significant delay in important conversations about changes in management and prognosis. The National Institute for Health and Care Excellence (NICE) describes how prognosis should be discussed ‘as soon as it is recognised that [the patient] may be entering the last days of life’ and that prognosis should be clearly documented in the patients’ care record to facilitate shared decision making.
Method(s) A retrospective case note review and audit was undertaken using data from patients who died in August 2020 in a large tertiary hospital in the West Midlands. Data collected included age, gender, diagnosis, details of admission, any changes in management and prognosis, any communication with relatives documented in the care record, and the presence of relatives in the last days of life.
Results Of the 67 cases audited, 42% had a clear documentation of prognosis in the case record prior to death. The average time delay between the identification of a significant patient deterioration and when this was communicated to the Next-of-Kin was 3.78 hours, and 3 cases had a delay of over 24 hours. A potential correlation was also identified between those who had the longest delay, and those who were least likely to have Next-of-Kin present in their last days of life.
Conclusion(s) Most conversations to notify Next-of-Kin of a significant deterioration were had within 4 hours of the deterioration. However, prognosis is not always clearly documented in the case record which raised potential for standardisation and creation of protocol to aid this process.
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