Improving Quality of End-of-Life Care in an Acute Palliative Ward

Year Submitted: 2025
Published Date: 17 April 2025

Tags: Care Continuum, End-Of-Life Care, Palliative Care, Preventive Care, Patient Education, Care Process ＆ Redesign, Quality Improvement, Job Redesign, Value Based Care, Safe Care

About this Content

Aims

To improve the quality of end-of-life care (EOLC) in our acute inpatient palliative care ward and achieve 100% of patients whose care meet the criteria for all five identified domains of high quality EOLC.

Background

High quality EOLC involves addressing psychosocial, spiritual and physical needs of patients and their caregivers. Despite robust evidence that measuring the quality of EOLC shapes how and what care is delivered, there is much less consensus on what these indicators should be. No clear measures have been developed and tested in patients who may have a variety of diseases, different trajectories of dying, in different settings and with different cultural and family contexts.

Methods

Domains that addressed the various aspects of high-quality EOLC were identified based on the current international literature and local cultural context. Domains were prioritized through discussion amongst Palliative Medicine Specialists, and five that were most important were reached in consensus. Education was provided to the team on delivery of these aspects of care, and a standardized framework was developed. Each death on the acute palliative care ward was audited through weekly meetings over a 5 month period to collectively decide if each domain was achieved.

Results

31 deaths over a 5 month period. Key indicator of quality of EOLC: % of patients who meet criteria for all 5 domains. Overall trend of improvement in quality of EOLC. Not always possible to recognize the terminal phase due to sudden or rapid deterioration in clinical condition. Dip in July with new junior medical staff who had not received adequate education on how to provide this care. Main area for improvement in domain 3 – achieved in 68%.

Conclusion

The quality of EOLC is an important aspect of good Palliative Care and can be achieved through quality improvement interventions such as having clear indicators, standardization, building awareness, and education.

Lessons Learnt

Auditing and objective measures of care quality deepen improvement culture and prioritize patient safety. Structured approach minimizes variability in care and enhances overall quality of service. Regular review and team discussion foster a culture of continuous improvement. Weekly audit provides an opportunity for debriefing. Culture of learning and collaboration promotes joy in work.

Additional Information

Delivering high quality EOLC brings meaning and fulfillment. Explore matters of importance and shared decision making on treatment options, preferred place of care, and preferred place of death. Symptoms adequately managed and anticipatory medications prescribed. Specific cultural, spiritual, and religious practices thoroughly explored and documented. Prepare and support patients, families, and staff in recognition of dying phase. Identify individuals at risk of complicated grief and provide MSW support for appropriate follow-up.

Keywords

End-of-Life Care, Palliative, Quality Improvement, Patient Safety

Innovators' Details

Connect with this contributor!

KTPH & YCH Innovation & Improvement (I&I) Office - i-i@ktph.com.sg

Project Attachment

772_KTPH_OIF 2025_Improving Quality of End of Life Care in an Acute Palliative.pdf