Some one in five acute hospital patients could have died at home if there were enough supports, according to a national audit of end-of-life care in hospitals.
The report published today by the Irish Hospice Foundation says that admissions through emergency departments have a negative impact on patients who die in hospital and it should be possible to arrange more planned admissions.
The audit found significant weaknesses in how the hospital system responds at each stage of a patient's journey, from admission through to death, with variations not only between hospitals, specialties and wards but within them also.
It looked at 24 acute hospitals, 19 community hospitals and collected information on 1,000 deaths from doctors, nurses and relatives.
The report calls for more single-rooms, improving the physical environment of multi-bedded wards and ensuring wards have sufficient staff.
It says most hospital staff receive little or no preparation for the death of patients and there needs to be better communication with patients.
The report reveals that the quality of dying in hospitals varies, depending on the patient's disease.
The best end-of-life care is experienced by patients with cancer and circulatory diseases, with the poorest experience for patients with dementia or frailty.
The report found that doctors underestimate the negative aspects of care, relatives over-estimate them, while nurses hold an intermediate position.
On sudden deaths, one-third of relatives do not seem to have been informed about the reasons for a post-mortem examination.
The Irish Hospice Foundation has published new quality standards for end-of-life care on foot of the audit, which was produced in association with the HSE and financial support from The Atlantic Philanthropies.