For QEII’s Palliative Care team, there is no one definition of a ‘good death’. 

“Dying is a multifaceted and individualised experience. A good death may be different for each patient,” said Director of Metro South Palliative Care Service, Dr Arvind Gunasekaran.

“The team spends time talking with our patients, getting to know them, and their families and identifying their wishes.”

QEII Hospital’s Palliative Care team was recently acknowledged as one of the best performing services out of a 16-hospital peer group across Australia and New Zealand in the 2022 Health Round Table’s Quality of Dying Audit. 

The audit considered issues such as pain, discomfort, respiratory distress, agitation, anticipatory care and holistic care at the end of life, as well as the consistency in the provision of the care designed to address such issues. 

According to Dr Gunasekaran, the result is not only due to the excellent care provided by the team but also their proactive approach in engaging with inpatient colleagues to identify and care for patients at the end of life.

“Recently, the palliative care team commenced chart reviews on patients who have had Medical Emergency Team calls to identify and address any palliative care needs that may exist, like clarification of goals of care, advance care planning discussion and symptom management.”

Teamwork and unity are essential to the success of the Palliative Care team – made up of nurses, medical staff, a counsellor, a social worker, an occupational therapist, a pharmacist, and an admin officer, with significant contributions from operational services staff. 

“We have lots of positive feedback from patients and families who appreciate our work and the space we provide them to enjoy their limited time together,” said Dr Gunasekaran.
 
One patient’s family recently provided the below feedback: "We take this opportunity to thank the most amazing staff of QEII 3A who left no stone unturned in their skilful and gentle care in Ben’s* dying, even caring so wonderfully for the family as well. Bless you all. You are all angels without wings who enabled Ben* to die in great dignity." 
 
In conjunction with the Metro South Palliative Care Service this year, the team will pilot a quality improvement initiative called The Surprise Question Project. This initiative aims to evaluate a model of care that integrates a consistent recognition system using clinical trigger (surprise) questions to identify patients at the end of life.

“Routine use of surprise questions supports more consistent implementation of the End-of-Life Care Framework and prompts clinicians to make a holistic assessment to determine whether a patient might benefit from advance care planning, palliative care, or both,” said Dr Gunasekaran.

Staff across the hospital are encouraged to talk to the palliative care team if they have any questions or concerns while caring for patients at the end of life. The team are available to educate and upskill staff on anticipation and early identification of distressing end-of-life/palliative symptoms and other practical issues.

*name has been changed