Imminence of death of Scottish hospital inpatients

Imminence of death of Scottish hospital inpatients

As the population ages and the number of deaths increases, so the need for palliative care at the end of life is growing. How can clinicians and services identify those who might benefit from palliative care?

In March 2014 Professor David Clark and his team published a paper showing the likelihood of death within 12 months among a cohort of all hospital inpatients in Scotland on a fixed ‘census’ date.

It was the first time such a study had been conducted anywhere in the world. The study has been a call to action for hospitals to give greater priority to identifying inpatients who might benefit from palliative care.

A brief introduction to the imminence of death study

Background to the research findings and new directions

Richard Meade of Marie Curie Scotland on the questions raised by this study

The study from an NHS hospital perspective

What the study means for policymakers

The study attracted the attention of Scottish government officials and has been referenced in key documents relating to seven-day care. Professor Clark was invited to take the role of Consulting Editor during the production of Scotland’s Strategic Framework for Action on Palliative and End of Life Care.

Professor Clark uses the End of Life Studies blog to encourage discussion of the study and its findings.

More about the findings

The study established the number of hospital inpatients in an entire country who on a given day are within the last year of life.This study had no external funding but relied on complex record linkage analysis provided by NHS Scotland.

Published in Palliative Medicine, and quickly attaining the journal’s highest-ever Altmetrics score, Clark et al showed that among 10,743 inpatients in 25 Scottish teaching and general hospitals on 31 March 2010,  3,098 (28.8%) patients died during the one-year follow-up period.

The likelihood of dying rose steeply with age and was three times higher at one year for patients aged 85+, compared to those under 60. Perhaps most striking of all was the finding that in Scottish hospitals on any given day, almost one in ten patients (9.3%) will die before they leave.

Media responses to the study

With its clear implications for practice and policy, the study attracted a huge amount of media interest at the time of publication:

The study continues to inspire reports including:

A follow-up study confirms the findings, which suggest that the culture and organization of hospitals need to become more attuned to the high proportion of inpatients in imminent need of end of life care.  

The project has created significant international interest and is being replicated in an three-country comparison study including Denmark and New Zealand, using a new census date and methodology for all three countries.

Clark, D. Schofield, L. Graham, F. Jarlbaek, L. Gott, M. Isles, C. Hospital care in the last year of life. British Medical Journal rapid response, 12 August 2015

The work complements our wider research programme Global Interventions at the End of Life, funded by a Wellcome Trust Senior Investigator Award to Professor Clark, which seeks to understand how end of life interventions around the world are developed, implemented and assessed.

Related publications

Clark, D., Schofield, L., Graham, F. M., Gott, M. and Jarlbaek, L. (2016) Likelihood of death within one year among a national cohort of hospital inpatients in Scotland. Journal of Pain and Symptom Management, 52(2), e2-e4. (doi:10.1016/j.jpainsymman.2016.05.007) (PMID:27262261)

Clark, D., Schofield, L., Graham, F., Jarlbaek, L., Gott, M. and Isles, C. (2015) Hospital care in the last year of life. British Medical Journal, 2015(351), h4266. (doi:10.1136/bmj.h4266) (PMID:26253242)

Clark, D., Armstrong, M., Allan, A., Graham, F., Carnon, A. and Isles, C. (2014) Imminence of death among a national cohort of hospital inpatients: Prevalent cohort study. Palliative Medicine, 28(6), pp. 474-479. (doi:10.1177/0269216314526443) (PMID:24637342) (PMCID:PMC4845030)

David Clark, Christopher Isles, Fiona Graham, Andrew Carnon

infographic depicting a summary of the study results, created by Marie Curie

L-R: Ananda Allan, David Clark, Fiona Graham - members of the imminence of death of Scottish Hospital inpatients study team

L-R David Clark, Fiona Graham, Christopher Isles, Andrew Carnon