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Effect of a multidisciplinary ward-based intervention on end-of-life care for general medicine patients

Published online by Cambridge University Press:  19 October 2021

Michelle Soo Rui Ting Open the ORCID record for Michelle Soo Rui Ting [Opens in a new window] ,
Norshima Binte Nashi ,
Kai Ang Lin Elaine  and
Benjamin M.Y. Hooi Open the ORCID record for Benjamin M.Y. Hooi [Opens in a new window]
Michelle Soo Rui Ting*
Affiliation:
Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
Norshima Binte Nashi
Affiliation:
Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
Kai Ang Lin Elaine
Affiliation:
Division of Oncology Nursing, National Cancer Institute Singapore, National University Hospital, Singapore, Singapore
Benjamin M.Y. Hooi
Affiliation:
Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore, Singapore
*
Author for correspondence: Michelle Soo Rui Ting, Department of Advanced Internal Medicine, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074. E-mail: [email protected]
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Abstract

Objective

Providing good end-of-life (EOL) care for noncancer patients has been made a national priority in Singapore. A combined medical and nursing ward-based intervention known as the EOL care plan was piloted in a general medicine ward at our institution, aiming to guide key aspects of EOL care. The aim of this study is to assess the EOL care plan's effect on EOL care for general medicine patients.

Method

We conducted a retrospective cohort study on inpatients who died in a general ward under the discipline “General Medicine” from May to October 2019. We collected data around symptom management, rationalization of care and communication with families. The primary analysis compared care received by patients who died in the pilot ward with that of a control group of patients who died in other wards.

Results

In total, 112 records were included in the analysis. Pain assessment was more common in the pilot ward compared with the control group (35.3% vs. 6.3%, p < 0.001), as were anti-psychotic prescriptions for delirium (64.7% vs. 24.4%, p = 0.001). Fewer patients received blood glucose monitoring in the last 48 h of life in the pilot ward (69.5% vs. 35.3%, p = 0.007). There were also less frequent parameters monitoring in the pilot ward (p < 0.004).

Significance of results

The implementation of the EOL care plan was associated with process-level indicators of better EOL care, suggesting that it could have a significant positive impact when implemented on a wider scale.

Keywords

Clinical pathwaysEnd-of-life carePalliative care medicinePalliative care nursing
Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 6 , December 2022 , pp. 813 - 817
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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