Background COPD is a leading cause of morbidity and mortality worldwide with a high physical and psychological symptom burden. A joint Palliative Care and COPD Working Group was established in 2007 to address the needs of patients with end-stage COPD in Salford, England where there is a higher prevalence of COPD than the national average (2.4% vs 1.4%).The group reviewed referrals to SPCS over a 12-month period before and after commencing joint working to establish their source, reasons for referral, and outcome. Nine audit standards were derived for evaluation of future practice. Aim: To audit the referral, initial assessment and outcome of all referrals to SPCS in Salford between October 2010 and March 2011 for patients with a primary diagnosis of COPD and compare to data obtained in 2007/8.

Method A retrospective case note review of all referrals to Salford SPCS (hospital, hospice and community) using a standardised data collection tool. Results: 95 referrals received by SPCS in a 6-month period during 2010/11 were compared with 21 in a 12-month period in 2007/8. 57 referrals (39 patients) were analysed: Prognostic information was evident in 43 % vs 39% in 2007/8. 59% of patients were GSF registered at referral compared to 52% in 2007/8; with the majority discussed regularly at primary healthcare meetings. Overall, there was a higher symptom burden elicited and documented with advice given on additional treatment. Preferences for future care were discussed in 37% of assessments but only completed in 20%, compared to 28% in 2007/8.

Conclusion There was a significant increase in the number of referrals to SPCS between 2007/8 and 2010/11, with 1 in 4 patients accessing multiple services. Areas of practice improved in particular identification of symptom burden but further collaborative work is needed to promote advance care planning in this patient group.