Background The National Audit of Care at the End of Life (NACEL) is a national comparative audit of the quality and outcomes of end of life care in acute, community hospitals and mental health settings in England, Wales and Northern Ireland which comprises four separate elements, one of which is a case note review using a pre-designed template. Hospice UK amended the tool (with permission) to align with hospice care, and with the encouragement of the Executive Clinical Leads in Hospice and Palliative Care (ECLiHP) Executive, member hospices were invited to take part.

Aims (1) To test the suitability of the NACEL case note review tool for the independent hospice sector, and (2) To understand the level of care being experienced by those dying during their hospice admission, and of those important to them.

Methods Several iterations of the template were tested using Plan Do Study Act (PDSA) methodology, 81 hospices registered interest and 69 hospices undertook a review of deaths that occurred from 1 – 21 February 2023 and submitted their data.

Findings 54% (n=37) of hospices returned feedback; 95% stated they had all the information they needed, 100% stated they could access the online form.

“It was a very useful exercise which highlighted to us that we don’t write down everything in enough detail…” and ”there were too many questions so it took a long time to review each set of notes”.

Of the 650 case notes reviewed, 56 graphs of aggregated data were created in a report so that hospices are now able to use the data for their own improvement plans.

Conclusion This collaborative exercise was the first across independent hospices, and highlighted several areas of practice hospices can include in their improvement plans. In terms of the process, while overall successful, iterative changes could be made if further rounds of audit are considered.