Where people die is changing: early activity of a dedicated nurse-led end-of-life care ward in an acute hospital
Abstract
Introduction
Most in-hospital deaths occur on acute wards designed for cure, not comfort. In April 2026 our trust opened an 18-bed nurse-led end-of-life care ward in a quiet building apart from the acute site, with individual bays, a walled garden, daily specialist palliative care input and open visiting. Two referral pathways operate: patients in the last days of life, and fast-track discharge to preferred place of care. We report activity from the first eleven weeks.
Methods
Service evaluation using routinely collected data (14 April to 28 June 2026). Ward deaths, trust-wide deaths and discharge destinations were summarised descriptively and compared with historical trust-wide patterns.
Results
Forty-nine patients died on the ward in its first 49 days (approximately one death per day; 57% day, 43% night). By late June the ward accounted for a mean of 32% of all in-hospital deaths, and up to 44% of non-critical-care deaths in some weeks. Trust-wide weekly and monthly death counts remained within historical ranges, indicating redistribution of where people die rather than additional mortality. The largest referring specialties were geriatric medicine (29%), stroke medicine (22%) and general medicine (10%). Approximately twenty fast-track discharges were achieved in the first weeks: 55% to home or usual residence and 40% to a care home. More than fifty nurses applied for the six specialist posts.
Conclusions
Within one quarter, a nurse-led ward with specialist input became the place of death for around a third of hospital decedents, without altering total mortality. Findings are descriptive and early, but suggest a dedicated ward model can rapidly relocate dying from acute wards to a purpose-designed environment.
Comments
Really interesting work,…
Really interesting work, particularly how quickly the ward became the place of death for around a third of hospital decedents without changing overall hospital mortality. The dedicated environment, open visiting and daily specialist palliative care input sound like valuable features for patients and families at the end of life. I also think the fast-track discharge pathway is an important part of the model, giving patients more opportunity to reach their preferred place of care. It would be interesting to see feedback from families and staff as the service develops.
Thank you
Thank you, that is kind. The speed of the change surprised us too; the ward filled within days and has stayed full, and the redistribution of deaths without any change in total mortality is the finding that reassured our quality committee that we were moving dying rather than adding to it. Fast track discharge has grown faster than we expected (over a hundred by late September, roughly half to home and most of the rest to care homes), and it is now as much a part of the ward's identity as the dying pathway. Family and staff feedback is being collected through the trust's bereavement follow up process and a staff survey, and we hope to report both alongside the six month re audit. If you are at the meeting in Nottingham, do come and find me at the poster.
This is such an interesting…
This is such an interesting idea, we frequently have patients on the ward for EoL care, and as much as we try to create a calm environment, it is an acute ward and is loud and hectic and not the ideal environment for peaceful end of life care. I imagine the feedback from families would be very positive and that a ward dedicated to EoL care gives ypu the time and space to provide real person-centred care.