BMJ  2007;334:652 (31 March), doi:10.1136/bmj.39164.410532.1F

Letters

A good death

Dying on the acute take can be improved

Although it may be preferable to predict outcomes and allow for death in the community, numerous patients with chronic illnesses in whom death may be expected or patients with severe and significant comorbidites will be admitted to acute medicine.¹

We recently performed a retrospective audit of patients admitted through the medical admissions unit who subsequently died. Death did not come as a surprise in 21/23 patients; seven of the 21 patients had terminal cancer, and nine had severe infection with severe comorbidities. An average delay of 11 hours occurred from recognition that the patient was dying to institution of any palliative measures. Of the terminally ill patients, six were judged to have had adequate palliation, 10 received no palliative drugs, and five received minimal palliation. The commonest reason for withholding palliative drugs seemed to be a trial of active treatment in the first instance.

Care of dying patients in acute medicine may not always be seen as a priority. However, these patients should be recognised early—so that symptomatic treatment can be used to ensure a comfortable death and enable the patient and family to prepare for death.² These measures can be instituted alongside active management (where appropriate) in this group of patients who are sick enough to die.

Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP

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Competing interests: None declared.

References

1. Dy S, Lynn J. Getting services right for those sick enough to die. BMJ 2007;334:511-3. (10 March.)[Free Full Text]
2. Ellershaw J, Ward C. Care of the dying patient: the last hours or days of life. BMJ 2003;326:30-4.[Free Full Text]

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