We read with familiarity and sadness the journey of Andrew, a
teenager in his last few days of life, written by his mother, Stephanie.
It highlights the potential problems encountered by patients and their
families at the end of life when cared for in the acute hospital setting.
This can sadly be a familiar story.
Recent government directives have given patients the choice to
consider end of life care at home. For some this is wanted and hopefully
achievable, but for others, their initial desire to stay at home may
change for both predictable and unpredictable reasons. Stephanie states,
“Unbearable pain usually strikes in the middle of the night, with arrogant
disregard for office hours” and as in Andrew’s case, many patients are
admitted to hospital at this stage.
The environment of acute busy wards is not always appropriate for the
needs of a dying patient and their families. Stephanie acknowledges that
Andrew felt safer in the hospital setting, but states “ dying in such a
unit is not the best choice, if one has a choice, with constant pressure
for the admission of patients that can be treated successfully it is not a
good use of resources to use such a unit for palliative care only”.
The “successful treatment “of an acute medical or surgical problem
needs to take place on acute wards. Likewise ‘successful treatment’ of the
dying patient with complex needs to take place in a suitable environment
with highly skilled staff. Such Specialist Palliative Care units do exist
in acute trusts for ‘palliative care only’ to provide a seamless service
for dying patients in this setting. These units have a variety of
additional roles, which may help to overcome the “End of all hope when
treatment stops and palliative care takes over”, as perceived by many
patients, families and health care professionals. They are also, at times
able to take patients whose ongoing need for medical support makes
transfer to a hospice inappropriate
Such NHS run Palliative Care Units on the sites of acute hospitals
are undoubtedly a step forward to provide active palliative care of
patients. But how do we measure this? Unfortunately, because the benefits
of such units are not easy to measure, there have been threatened closures
of such units in our region. We are concerned that the extinction of such
units will result in suboptimal care of the dying and the problems
encountered by families like Andrew’s will increase. Perhaps the
government should be listening to the views of carers, who have first hand
experience of relatives dying on acute busy wards, when considering such
closures?
Competing interests:
None declared
Competing interests:
No competing interests
29 June 2006
Jane Gibbins
Specialist Registrar Palliative Medicine
Colette Reid, Carolyn Campbell, Catherine Blinman, Zena Kassim, Specialist Registrars in Palliative Medicine in the South West Region
Rapid Response:
Deaths on acute hospital wards
We read with familiarity and sadness the journey of Andrew, a
teenager in his last few days of life, written by his mother, Stephanie.
It highlights the potential problems encountered by patients and their
families at the end of life when cared for in the acute hospital setting.
This can sadly be a familiar story.
Recent government directives have given patients the choice to
consider end of life care at home. For some this is wanted and hopefully
achievable, but for others, their initial desire to stay at home may
change for both predictable and unpredictable reasons. Stephanie states,
“Unbearable pain usually strikes in the middle of the night, with arrogant
disregard for office hours” and as in Andrew’s case, many patients are
admitted to hospital at this stage.
The environment of acute busy wards is not always appropriate for the
needs of a dying patient and their families. Stephanie acknowledges that
Andrew felt safer in the hospital setting, but states “ dying in such a
unit is not the best choice, if one has a choice, with constant pressure
for the admission of patients that can be treated successfully it is not a
good use of resources to use such a unit for palliative care only”.
The “successful treatment “of an acute medical or surgical problem
needs to take place on acute wards. Likewise ‘successful treatment’ of the
dying patient with complex needs to take place in a suitable environment
with highly skilled staff. Such Specialist Palliative Care units do exist
in acute trusts for ‘palliative care only’ to provide a seamless service
for dying patients in this setting. These units have a variety of
additional roles, which may help to overcome the “End of all hope when
treatment stops and palliative care takes over”, as perceived by many
patients, families and health care professionals. They are also, at times
able to take patients whose ongoing need for medical support makes
transfer to a hospice inappropriate
Such NHS run Palliative Care Units on the sites of acute hospitals
are undoubtedly a step forward to provide active palliative care of
patients. But how do we measure this? Unfortunately, because the benefits
of such units are not easy to measure, there have been threatened closures
of such units in our region. We are concerned that the extinction of such
units will result in suboptimal care of the dying and the problems
encountered by families like Andrew’s will increase. Perhaps the
government should be listening to the views of carers, who have first hand
experience of relatives dying on acute busy wards, when considering such
closures?
Competing interests:
None declared
Competing interests: No competing interests