Background Patients with chronic kidney disease, whether on dialysis or not, frequently die in the acute hospital and have a high symptom burden. In New South Wales, a state-wide RSC service has been established to provide palliative support to nephrology services.
Null hypothesis No significant improvement in indicators of quality of death at 5 and 10 years after establishment of RSC services.
Methods Retrospective chart review of all deaths in the acute hospital under a Nephrology service in the years 2004 (establishment of RSC), 2009 and 2014 at St George Hospital (SGH) and in 2009 (establishment of RSC) and 2014 at Concord Repatriation General Hospital (CRGH). There is a plan to assess deaths in 2019 at this site. Domains assessed were recognition of dying, avoidance of invasive interventions, symptom assessment, anticipatory prescribing, documentation of spiritual needs and bereavement information for families. End of Life Care Plan use was also evaluated at STG.
Results At SGH over 90% of patients were recognised to be dying in all 3 years. CPR rates did not differ between the 3 years. There was an increase in the documentation of respiratory secretions (p=0.01). Rates of interventions in the last week of life did not differ. Use of EOLCPs significantly increased over the 3 years (p=0.01). There was a significant increase in prescription of anti-psychotic (p=0.008), anti-emetic (p=0.002) and anti-cholinergic (p=0.03) medication.
At CRGH there was no significant change in any domain from 2009 to 2014. There was a non significant trend towards improved recognition of dying (63% to 92%).
Conclusion There was an increase in the use of EOLCPs and anticipatory prescribing at SGH, but not at CRGH, which may mean that 10 years are required after the establishment of RSC services before real changes to patient care are seen.
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