25 What can we learn from the National Audit of Care at the End of Life (NACEL) pilot about deaths in emergency departments?

Introduction NACEL reviews the quality of care for people dying in hospitals in England, Wales and Northern Ireland. The retrospective audit examines care during the final admission of the patient's life, drawing data from health care records, bereaved persons survey, staff survey and organisational level data. It underwent review and redesign in 2023. Methods As part of the pilot, the revised data specification form gathering information from the health care record was used to assess the quality of care in emergency departments (ED). Anonymised data was submitted to NHS Benchmarking for analysis. Results 4 English hospital Trusts reported on 72 ED deaths (13% of all deaths in the pilot sample, 0.3% of annual ED deaths in England). 51% of patients presenting to ED were not expected to die, but 78% were recognised as sick enough to be at risk of dying on presentation. 54% of deaths in ED happened within the first four hours following presentation. 13% of patients had a palliative care team review compared to 55% of people dying as inpatients. The ethnicity of people presenting was recorded as white British 49%, Asian or Asian British: Indian and Pakistani 10%, unrecorded 36%. The ethnicity of people dying as inpatients was 77%, 4% and 16% respectively. The sample size does not support valid comparison about other data collected. Conclusion The number of deaths in EDs need to be routinely reported at national level to understand trends. A statistically valid sample needs to be audited to understand the quality of care provided to those who are dying in ED and to those who are important to the patient. Results of the audit will offer opportunities for quality improvement.