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Abstract：
Objective The aim of this study was to map end-of-life care in acute hospital settings against Elements 1-5 of the Australian Commission on Safety and Quality in Health Care\'s (ACSQHC) Essential Elements for Safe and High-Quality End-of-Life Care. Methods A retrospective medical record audit of deceased in-patients was conducted from 2016 at one public (n = 320) and one private (n = 132) hospital in Melbourne, Australia. Ten variables, key to end-of-life care according to the ACSQHC\'s Elements 1-5 were used to evaluate end-of-life care. Results Most patients (87.2%) had a limitation of medical treatment. In 91.97% (P < 0.0001) of cases, a written entry indicating poor prognosis preceded a documented decision to provide end-of-life care, with a documented decision noted in 81.1% of cases (P < 0.0001). Evidence of pastoral care involvement was found in 41.6% of cases (P < 0.0001), with only 33.1% of non-palliative care patients referred to specialist palliative care personnel (P = 0.059). An end-of-life care pathway was used in 51.1% of cases (P < 0.0001). Conclusion There is clear scope for improvement in end-of-life care provision. Health services need to mandate and operationalise Elements 1-5 of the ACSQHC\'s Essential Elements into care systems and processes, and ensure nationally consistent, high-quality end-of-life care. What is known about the topic? Acute care settings provide the majority of end-of-life care. Despite the ACSQHC\'s Ten Essential Elements, little is known about whether current end-of-life care practices align with recommendations. What does this paper add? There is room for improvement in providing patient-centred care, increasing family involvement and teamwork, describing and enacting goals of care and using triggers to prompt care. Differences between public and private hospitals may be the result of differences in standard practice or policy and differences in cultural diversity. What are the implications for practitioners? The Essential Elements need to be mandated and operationalised into mainstream care systems and processes as a way of ensuring safe and high-quality end-of-life care.
摘要：
目的本研究的目的是根据澳大利亚卫生保健安全与质量委员会（ACSQHC）的要素1-5绘制急性医院环境中的临终护理，以实现安全和高质量的临终护理。方法从2016年开始，在墨尔本的一家公立（n=320）和一家私立（n=132）医院对住院患者进行回顾性病历审核。澳大利亚。十个变量，根据ACSQHC的要素1-5，生命结束护理的关键用于评估生命结束护理。结果大多数患者(87.2%)的药物治疗存在局限性。在91.97%(P<0.0001)的病例中,在有文件记录的提供临终护理的决定之前，有一份表明预后不良的书面条目，在81.1%的病例中记录了有记录的决定（P<0.0001）。在41.6％的病例中发现了牧师护理参与的证据（P<0.0001），只有33.1%的非姑息治疗患者转诊至专科姑息治疗人员(P=0.059).51.1%的病例使用了临终关怀途径(P<0.0001)。结论临终关怀提供有明显的改善空间。卫生服务需要将ACSQHC基本要素的要素1-5授权和实施到护理系统和流程中，并确保全国一致，高品质的临终关怀。对该主题有什么了解？急性护理环境提供了大多数临终关怀。尽管ACSQHC的十大基本要素，对于目前的临终关怀实践是否与建议一致，人们知之甚少。本文补充了什么？在提供以患者为中心的护理方面还有改进的空间，增加家庭参与和团队合作，描述和制定护理目标，并使用触发器来提示护理。公立和私立医院之间的差异可能是标准实践或政策差异以及文化多样性差异的结果。对从业人员有什么影响？基本要素需要被强制纳入主流护理系统和流程，以确保安全和高质量的临终护理。
