Intended for healthcare professionals

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Spotlight Spotlight: Palliative Care Beyond Cancer

Achieving a good death for all

BMJ 2010; 341 doi: (Published 16 September 2010) Cite this as: BMJ 2010;341:c4861

Rapid Response:

The Imminence of death and the Liverpool Care Pathway

In their article 'Achieving a good death for all' Ellershaw and
colleagues state that the Liverpool Care Pathway (LCP), or equivalent, is
"aimed at improving care of the imminently dying". 1 But how imminent is

A retrospective review of all deaths (N=188) carried out by one of
the authors (MM) in an acute hospital for the months April and August 2010
revealed that 61% of patients were eligible for the LCP. However of all
deaths only 78 (41%) patients received care on the LCP. The length of time
on the LCP ranged from 1 hour to 31 days (median 23 hours). Of patients on
the LCP 20 (26%) were on longer than 72 hours and 10(13%) longer than 5

This audit echoes the point made by Clearkin that prediction of dying
-the last 48 hours- is difficult. 2 Some deaths are not predicted and
those clinically judged 'imminent' can be prolonged. The audit reinforces
the need for meticulous regular monitoring and clinical assessment for
each patient placed on the LCP. It highlights the need for particular
consideration for hydration as 1 in 5 patients may be expected to live
longer than 3 days.

The LCP is in our view a very useful tool which may help achieve a
good (or better) death in up to 60% of people in whom death can be
anticipated. The imminency for most will be less than 3 days but for a
substantial minority it will be considerably longer.

Competing interests: No competing interests

29 October 2010
Edwin J Pugh
Mel McEvoy
North Tees and Hartlepool Foundation Trust