Acute care is the place of death for approximately 50% of all deaths in Australia.  Within the acute care setting many patients will be identified as requiring palliative care. Some will require ongoing care within the hospital and/or after discharge, others will be actively dying and require terminal care. Individuals currently receiving palliative care may be admitted if their condition deteriorates or complexity increases requiring acute medical or surgical intervention, pain management, or symptom control. Recognising that a person is approaching end-of-life is essential to:
It is also important to recognise whether the person is actively dying and death imminent.
There are a number of tools currently in use within the acute care setting to assist health professionals in the identification of patients with palliative care needs. These support but do not replace clinical judgement and effective use requires collaboration and a multidisciplinary approach. 
The Surprise Question (367kb pdf)
Supportive & Palliative Care Indicators Tool (SPICT)
NAT-PD (128kb pf)
Gold Standards Framework - Proactive Identification Guidance (PIG) – 7th
Australian-modified Karnofsky Performance Scale (AKPS)
Physical performance state also has prognostic significance, especially in advanced cancer. The Australian-modified Karnofsky Performance Scale (AKPS) is a measure of a patient’s overall ability to undertake activities of daily living.
The signs that a person may be entering the terminal phase include:
Visit End-of-Life Essentials, Recognising the End-of-Life module.
Take the End-of-Life Essentials module
Knowing whether a person is entering the last days of life or stabilising or if there is potential for even temporary improvement can be difficult, as signs might be inconsistent or fluctuating.
Useful Tools include:
Use the End-of-life Essentials toolkit action checklist to guide recognising the end-of-life.
End-of-Life Essentials Action Toolkit (535kb pdf)
Access the Toolkit
Care for the person with palliative care needs will depend on individual needs and phase of illness.
Watch Professor Paddy Stone discuss the role of prognostic information and the role it plays in reducing the prevalence of burdensome treatments at the end-of-life.
Video from Palliative Care NSW
Use the RUN-PC Triage Tool Calculator
Visit CareSearch Prognosis review collection
Read Evidence Check - Tools to aid clinical identification of end of life (1.57MB pdf)
Last updated 22 November 2022