Background A 21 month Macmillan Funded Programme has been undertaken to transform weekend and bank holiday Specialist Palliative Care (SPC) provision in Salford. This has tested the proposed APM model, increasing the level of 7 day working staffing from the minimum to Level 1 with elements of Level 2.
Method In addition to the established Senior Clinical Nurse Specialist (SCNS) rotas in hospital and community, new Advanced Clinical Nurse Specialists (ACNS) with enhanced clinical skills have delivered senior SPC face to face reviews across care settings. For 50% of weekends, medical consultant face to face review has also been available. Outcome measures have been developed.
Results Over 600 complex patients have had senior SPC review at the weekend, across care settings in the initial 10 months. Average hospital weekend referrals have increased by 37% (from 16.9 to 23.1) with improvement in hospital weekend response times (81.2% Vs 69.6% seen within 24hrs).
Reduction in symptom and Psychosocial scores has been demonstrated, with patients and carers feel well supported by the responsiveness of the teams. Increase in documented advance care plans from 26% to 67%. Over 70 GP home visits prevented by the community Urgent Response service in 6 months. Demonstrated avoidance of inappropriate hospital admissions and the trend towards reduction in hospital length of stay equate to potential annualised saving of 1,360 bed days or 3.7 beds per year. Improved career pathway for CNSs and support for SCNSs by ACNSs.
ACNSs have delivered service improvement projects:
One Stop COPD Clinic
Emergency Assessment Unit and Emergency Department in–reach
A pioneering ‘10 in 10’ education programme
‘Urgent Response’ community work
Support to GPs to improve GSF meetings
Conclusion This model has demonstrated patient, carer, staff and cost benefits as well as addressing issues with inequity of service delivery and capacity across care settings.
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