Aims and Objectives Suboptimal end of life care is being increasingly recognised in hospital and a change in attitude or education may provide a significant improvement. The purpose of this study was to outline if there was a discrepancy in patient care in in the acute medical unit and discuss the need for improvement. All clinicians should be able to “identify adults approaching the end of life” and “should have skills to provide care for adults approaching the end of their life” as per NICE guidelines. This study focused on the delivery of EoL care in the emergency and acute medical services and assessed whether this met NICE standards.

Method and Design Data collected over a 1-month period of patients who died less than 24 hours of admission in A&E or AMU at Royal Blackburn Hospital. We reviewed documentation and decided whether recognition of dying was made during doctors’ assessments, when the dying process was recognised, whether symptom-focused management medications were prescribed and recorded if referral to palliative care was considered.

Results and Conclusion 44 patients met selection criteria. 10/44 patients had recognition of possible active dying on admission. 32/44 had anticipatory medications prescribed. 6/44 were considered for referral to palliative care. 36/44 remained on active treatment prior to death.

This study suggests that there is a slowness in the recognition of the dying patient and prioritising patient-focused symptom management. Recognition of dying is an essential first step in improving care for dying patients, perhaps a criterion score would be helpful in practice such as the “traffic lights” model or the “palliative performance score.” Education with the palliative care specialists would likely benefit departments. There was a predominant theme of patients being actively managed up until the point of dying, is there a cultural reasoning behind acute physicians leaning towards active treatment and not accepting dying as an outcome?