Rapid review of the literature to inform the development of quality and safety indicators for end-of-life care in acute hospitals
Australian Commission on Safety and Quality in Health Care
Duration: March – June 2016
The Australian Commission on Safety and Quality in Health Care (the Commission) commenced a program of work about end-of-life care in acute health care settings in 2012.
This work informed the development of new actions about end-of-life care in the draft version 2 of the National Safety and Quality Health Service (NSQHS) Standards. A key aspect of safety and quality improvement is the ability to evaluate interventions and continuously improve systems for delivering care. Indicators for evaluating end-of-life care are needed to support health service organisations across Australia to implement systems that meet the requirements of version 2 of the NSQHS Standards.
The Commission engaged CHSD to undertake a rapid review of the literature to inform the development of quality and safety indicators for end‐of‐life care in acute hospitals. This was in responses to the Commission identifying that there was little robust evidence to guide the delivery of end-of-life care in acute settings which was highlighted in a national consensus statement about the provision of safe and high-quality end-of-life care. The aim of the review was to provide recommendations to inform the development of quality and safety indicators for end-of-life care in acute hospitals.
What we did
Initial discussions with the Commission resulted in a clear understanding that development of quality and safety indicators for end-of-life care should be driven by a patient-centred approach to care delivery and the burden of data collection for the indicators should not be too onerous. The scope of the rapid review was to include structural, process and outcome indicators.
The project was composed of three stages: (1) searching the literature; (2) reviewing the literature; and (3) synthesising the findings and making recommendations to the Commission. The review identified 27 papers describing the development and use of 12 sets of indicators, including a total of 208 indicators. Almost 70% of the 208 indicators were indicators of process, with much less emphasis on indicators of structure or patient outcomes. About 35% of the indicators were based on some aspect of symptom management, with pain, dyspnoea and psychological symptoms being the most frequently occurring symptoms. Three of the quality indicator sets relied on questionnaires to collect data from patients or their families and one set of indicators relied on the prospective collection of clinical data from patients.
The testing and use of the sets of indicators identified by this review had been very limited. None of the work had been undertaken in Australia. The findings suggest that developing and implementing a set of quality and safety indicators for end-of-life care in acute hospitals will require careful thought and a considerable amount of methodological research. Six recommendations were included for consideration, with a particular emphasis on building on the work undertaken for this report.