Letters Liverpool care pathway

Evidence base needs to be developed for the whole process of end of life care

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1843 (Published 26 March 2013) Cite this as: BMJ 2013;346:f1843
  1. Suzanne M Kite, lead clinician, palliative care1,
  2. Fiona Hicks, consultant in palliative medicine1,
  3. Elizabeth Rees, lead nurse, specialist palliative care team1,
  4. Claire Shepherd, end of life care facilitator1,
  5. Christopher Stothard, end of life care facilitator1
  1. 1Leeds Teaching Hospitals NHS Trust, St James’s University Hospitals, Leeds LS9 7TF, UK
  1. suzanne.kite{at}leedsth.nhs.uk

Despite the BMJ survey’s limitations,1 we welcome systematic attempts to develop the evidence base necessary to move forward the debate on the Liverpool care pathway (LCP).

The Leeds Teaching Hospitals NHS Trust started implementing the LCP framework in 2005, on a ward by ward basis, working closely with specialties and supported by facilitator led training for doctors and nurses. Implementation to all 66 wards that provide end of life care for adults was completed in 2011.

End of life care facilitators continue to sustain good practice. Participation in the National Care of the Dying Audit—Hospitals (NCDAH)2 can provide assurance; in the 2008-09 audit the continuation of intravenous fluids in a third of our patients reassured us that the LCP was being tailored to individuals’ needs.3 However, the NCDAH is a documentation audit of the LCP alone, not complete case notes. The 2011-12 audit did not provide adequate assurance about communication with patients and families, owing to gaps in LCP documentation.2 We therefore audited the case notes for the week before the LCP began in a random sample of 40 patients who died supported by the LCP. We found evidence of clear communication of the likely imminence of death with all families (versus 90% documentation in LCP) and explanation of the end of life care plan for all families (55% documentation in LCP).

Future national care of the dying audits must examine the whole process of end of life care decision making and communication because audit of LCP alone can be misleading. The LCP framework is appropriate only after making a multiprofessional diagnosis of dying within the context of thorough patient assessment and communication, and with consultant endorsement (99% within Leeds Teaching Hospitals).2


Cite this as: BMJ 2013;346:f1843


  • Competing interests: All authors are members of the Leeds Teaching Hospitals palliative care team, and SMK is lead clinician. The palliative care team leads on the LCP across the acute trust.

  • Full response at www.bmj.com/content/346/bmj.f1184/rr/634951.