Background There is an expressed preference by the general population to die at home, however in the UK 58% of people die in hospital. The Royal Marsden NHS Foundation Trust, with the co-operation of their Community Partners, has employed a case conference model to support patients achieving their preferred place of death (PPD). Patients with no further oncology treatment available are offered a case conference in their homes where a Clinical Nurse Specialist (CNS) from the hospital hands over to the community professionals in the presence of the patient. The service is called Hospital2Home (H2H). The belief is that by working together, with the patient at the centre, communication and co-ordination will improve, ensuring the patient is in the right place with the right people despite their changing condition.
Aims The aim of this audit is to evaluate the H2H service in terms of case conference length, attendees, issues discussed and outcomes (place of death and achievement of PPD). Methods: This is an audit of all conferences over a 4 year period. Data was collected during routine assessments by the H2H staff. Analysis included; demographics, attendees, issues discussed and place of death.
Results Of 308 case conferences 270 of the patients have died. Case conferences were attended by: Patient 92%; Carer 97%; GP 78%; DN 89%; CNS 87% and Social worker 11% Discussions included: pain 93%; other symptom control 99%; functional issues 96%; psychological issues 93%; social issues 95%; spiritual religious issues 22%. The majority of case conferences (70%) lasted under 1 h Place of death: home 47%; hospice 36%; hospital 10%; nursing home 6% and other locations 1%. Overall, this equates to 83% congruence between actual and preferred place of death.
Discussion Collaborative working across organisational boundaries is possible and can improve PPD outcomes at the end of life.
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