Background The national SEECare audit aimed to evaluate the provision of generalist-led end-of-life care in hospital adult in-patients. The audit was replicated within NHS Ayrshire and Arran in June 2022. Results of the SEECare audit are predicated on hospital teams recognising when patients not known to specialist palliative care are dying. Local audit identified that hospital teams are not recognising that patients are dying timeously and further investigated this.

Methods As a supplement to the SEECare audit, the number of hospital in-patients who died in the 7 days following the snapshot audit were identified, and their age and cause of death investigated.

Results 7 acute hospital in-patients were identified by their parent team as imminently dying. A further 17 patients who would have been eligible for inclusion in the audit died in the subsequent 7 days.

Median number of days from the audit to death was 4 days. 71% of these patients had an infection listed as their primary cause of death and mean age of these patients was 77 years (versus 85 years for those identified as dying).

Conclusion The SEECare audit format assesses quality of end-of-life care for patients identified as dying. There is a risk that those not identified as dying receive poorer quality end-of-life care. The majority of the patients not identified as dying, but who subsequently did, had an infection listed as their primary cause of death. This may signify uncertainty of response to antimicrobial treatment. This prognostic uncertainty should be shared with patients and carers to allow full assessment of their holistic needs. The difference in mean age between those identified as dying and those not may reflect doctors erring on the side of erroneously continuing treatment in younger patients.