Palliative Care

Struggling with the last breath: breathlessness at the end of life on the AMU

Clinical Reviews, Volume 18, Issue 2, Pages 61 – 136 (2019)

Breathlessness is one of the most common symptoms experienced at the end of life, affecting all areas of a patient’s life. It is frightening and leads to high rates of emergency hospital attendances. Often, there is no easily reversible cause and patients are admitted to the acute medical unit (AMU) in order to manage their symptoms with little overall benefit – frustrating patients and clinicians alike. This review reminds the generalist of the significance of breathlessness as a symptom. It highlights the management strategies available to effect improvement and gives practical tips on how this can be achieved within the busy and time-pressured environment of the AMU.

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Unscheduled care admissions at end-of-life – what are the patient characteristics?

Research Audit and Clinical Practice, Volume 15, Issue 2, Pages 49 - 108 (2016)

Unscheduled acute hospital admissions and subsequent deaths in hospitals of patients considered palliative are increasing, despite many patients’ preference to die at home. A large proportion of these patients are admitted via acute medical units or emergency departments. The integration of primary and secondary care within Wales should enhance the delivery of end-of-life care at home but unscheduled admission for patients with palliative care needs remains prevalent. The aim of our study was to explore the characteristics amongst patients who die shortly after unscheduled hospital admission. A retrospective, observational study was conducted in all unscheduled admissions at end-of-life at a single health board in South Wales, UK over a period of one month. The result showed that 47% of patients who died within 48hrs of unscheduled admission are considered to be palliative. The majority of these patients were admitted via 999 ambulances and out of normal working hours (65%). They were elderly (median age 80) and had a poor performance status (78%). Over 1/3 (39%) were admitted from a nursing or residential home. Less than a quarter (22%) had an advance care plan in place.

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Palliative Care – a useful speciality skill for trainees in Acute Medicine

Trainee Section, Volume 13, Issue 3, Pages 101 - 148 (2014)

I gained a run through number in ACCS (AIM and GIM) in 2007 when Acute Medicine, both as a training programme and a stand alone medical specialty, was in its infancy. As the programme has evolved and developed it has become a curriculum requirement for trainees to attain an acknowledged specialist skill.

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Palliative and end of life care on the Acute Medical Unit

Research Audit and Clinical Practice, Volume 13, Issue 1, Pages 1 - 52 (2014)

Abstract

Introduction: Early and appropriate recognition of patients requiring palliative care is essential to delivering high quality management and Acute Medical Units have a pivotal role to play in ensuring its implementation.

Aim: To identify the prevalence of patients admitted to Acute Medical Unit (AMU) who met palliative criteria, the overall prevalence of terminal diagnoses and the frequency of appropriate referrals to the units Palliative Care in reach team.

Methods: An audit was performed at a University Hospital AMU to examine these issues. The NHS Supportive and Palliative Care Tool (SPCIT) was used to identify palliative patients. 409 patients were admitted to the AMU during the study period.

Results: 66 (16.1%) of patients were identified as palliative. Two-thirds of these patients had a non-malignant diagnosis. 30% of palliative patients were referred to the palliative care team of which 85.4% had a diagnosis of cancer. 88% of patients that received ongoing palliative care review had a diagnosis of cancer.

Conclusion: There is a high prevalence of patients with a terminal diagnosis presenting to the AMU reflecting an aging population and increasingly complex co-morbidities. Palliative patients with a non-cancer diagnosis are less likely to be referred to the palliative care team, which has the potential to disadvantage their care.

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