National care of the dying audit hospitals (NCDAH) round 3 results

Background The UK Department of Health (DH) published national guidance in end of life care for the first time (DH 2008/2009), highlighting the Liverpool Care Pathway for the Dying Patient (LCP) as a best practice model of care in the last hours or days of life. After an extensive 2 year consultation process, resulting in important amendments around more explicit goals on hydration, nutrition and skin integrity, communication and guidance for diagnosing dying, the current LCP (Version 12) was published in 2009. The Marie Curie Palliative Care Institute Liverpool, in collaboration with the Royal College of Physicians, has undertaken round 3 of the National Care of the Dying Audit Hospitals (NCDAH). The NCDAH allows submission of data against 2 elements – organisational (all NHS Trusts) and clinical (LCP) elements of care delivery in the last hours or days of life. Data driven Key Performance Indicators (KPI) were developed for organisational and clinical elements of the audit. The NCDAH Round 3 has been included in the ‘Quality Accounts’ list of national audits promoted by the DH in 2011-2012, and is the first round to measure care delivery against outcomes on LCP V12. Aim Present findings of the NCDAH Round 3: • Organisational elements of care delivery and KPI9s • Clinical Outcomes: against core elements of care (LCP V12) • National implications for policy. Method Retrospective audit cycle: organisational and clinical elements of care in the last hours or days of life in hospitals in England. Findings 131 NHS Trusts have submitted organisational data, and 178 individual hospitals have submitted outcome data from 7058 patients whose care was supported by the LCP. Participation has increased by 13% from round 2. Conclusion Results will be discussed with national implications for policy, education and training, and key recommendations for improvements into the future.