Achieving the preferred place of care for hospitalized patients at the end of life

Background: The Department of Health end-of-life strategy contains a number of quality markers which include taking into account patients' wishes for their final place of care. There is a wide variation in how this information is recorded. Methods: An audit was conducted on discussion of preferred place of care (PPC) for all patients referred to the hospital palliative care team who died during the audit period. Barriers to achieving PPC and the efficacy of a fast track discharge service were also monitored. The audit was first done in 2007 and was repeated in 2009. Results: There was an increase in recording PPC. Overall PPC wishes were ascertained for 87% of the patients seen by the team. The PPC was achieved in 76% of cases. The number of patients wishing to die in hospital significantly increased over the audit cycle (from 10% to 30%). Approximately one-third of patients changed their minds regarding PPC. Conclusions: The data highlights the need to distinguish between preferred place of care and preferred place of death. Patients' wishes regarding PPC change as death approaches. A greater number of patients wished to die in hospital than was expected.