The importance of recognising dying: audit and subsequent service developments to improve earlier recognition of the dying patient

Abstract

Early recognition of the dying patient leads to better end-of-life care for patients and their relatives. In 2019, the National Audit for Care at the End of Life (NACEL) identified several areas for improvement in a large NHS acute trust, including delays in recognition of the dying patient. The audit showed that in this trust, 22% of dying patients were only recognised to be dying in the last 8 hours of life compared to 17% nationally. This has significant consequences on the quality of end-of-life care.

This article examines the challenges associated with recognising when a patient is approaching the end of life and highlights the significance of timely identification. In response to the findings of the 2019 NACEL audit, the Trust introduced several service developments, including the expansion of palliative care services, enhanced staff training with an emphasis on early recognition of dying, and improved processes for referring patients to palliative care. We have used descriptive statistical analysis, which is appropriate for an audit-based evaluation.

A subsequent reaudit conducted in 2022 demonstrated significant improvement; the proportion of patients for whom dying was recognised less than eight hours before death decreased from 22% to 10.4%.  Additionally, in 94% of cases, it was acknowledged that the patient may be dying, an increase from 85% in 2019. This article will summarise the key findings from NACEL, discuss their implications, and outline the interventions implemented that contributed to these improvements.