Background In 2018, Palliative Care Australia issued a report outlining nine standards which intended to guide and support the delivery of high-quality palliative care in Australia. Standard 8 encouraged services to structurally integrate quality improvement into their care provision.¹ The changing patient demographic marked by increasingly older patients affected by chronic disease and the growing variety of interventions available contribute to increasing complexity in palliative care.² Quality improvement seeks to address these emerging complexities and the knowledge gaps that exist. Its aim is to improve and develop service provision by identifying best practice in the care of individuals affected by life-limiting illness.^{2 3}

Objectives The quality and safety audit tool was introduced to improve palliative care service provision at Austin Health, a tertiary metropolitan public hospital in Victoria.

Methods The tool is utilised in fortnightly meetings attended by clinicians across the palliative care service. Contributing teams include the palliative care ward, consults, clinic, and outreach service. Aligned with the National Consensus Statement: Essential elements for safe and high-quality end-of-life care, fifteen ‘Quality Alerts’ form the framework used to systematically identify patient cases that warrant discussion.⁴ These ’Quality Alerts’ reflect the multidimensionality of palliative care and cover areas such as quality of death, challenging symptom management, family distress, voluntary assisted dying requests, care dissatisfaction, complex case management, service partnership issues and referrals for interventional procedures and outcomes. These cases and issues are then reviewed during these meetings, where actionable outcomes are documented and taken forwards by allocated clinicians. This process allows for internal ‘peer review’ to occur, demonstrating both successes in care and areas for improvement.² Providing a safe and approachable environment in which to explore these cases is essential to its efficacy.

Results This framework prompts regular dialogue about patient care and service provision, providing a space for clinicians to reflect and debrief. It has translated into service-wide benefits including the strengthening of interdepartmental relationships, furthering collaboration with community services, complex case discussions, identifying education and research opportunities, policy/guideline development and quality improvement projects. Further to this, it has and continues to create tangible outcomes for patients and carers with complex specialist palliative care needs. Collectively, it embeds a culture of quality and safety into local palliative care provision.

Conclusion The use of a quality and safety audit tool in a hospital-based palliative care service can drive quality improvement to support the delivery of high-quality palliative care to optimise patient outcomes.

References

1. Palliative Care Australia. National palliative care standards 5th edn; 2018.

2. Higginson IJ, Hocaoglu MB. Clinical audit, quality improvement, and safety in palliative medicine. In: Oxford Textbook of Palliative Medicine. Sixth. Oxford University Press; 2021. p. 1335–50.

3. Kamal AH, Nicolla JM, Power S. Quality improvement pearls for the palliative care and hospice essional. Journal of Pain and Symptom Management. 2017 Nov;54(5):758–65.

4. Australian Commission on Safety and Quality in Health Care. National consensus statement: essential elements for safe and high-quality end-of-life care. 2023.