Background The ‘Acute Intervention Team’ (AIT) is the culmination of a multi-disciplinary drive to better support parent teams to actively manage deteriorating patients and recognise and care for the patients where palliation is the most appropriate course.

Methods The AIT consists of Nurse Practitioners and Senior Health Care Assistants who, as well as possessing the skills of a typical critical care outreach team, have also received additional dedicated training in palliative and end of life care. This includes a period shadowing the Specialist Palliative Care (SPC) Team and bespoke training on recognition of potential lack of reversibility, diagnosing dying, management of palliative emergencies, symptom control and end of life care.

Results The Team have reviewed over 6000 patients since commencing clinical practice in December 2016. Just under half died during their admission, demonstrating how important palliative care is within the role. Whilst most referrals were for patients with high NEWS, notably 241 were referred by SPC for enhanced palliative support to wards out-of-hours. The percentage of cases where a DNACPR should have been in place for patients suffering a cardiac arrest reduced from 41% to 30% in 2017/18, and in 2018/19 reduced further to 17%. This demonstrates the team have had a positive impact on appropriate escalation planning. Palliative care coding has also significantly increased over this time, from 20% to 40% of deaths, reflecting improved palliative decision making and quality of care.

Conclusion This innovative team are addressing the challenges of providing good 24/7 end-of-life care for the approximately 2000 patients who die each year within CDDFT, allowing us to better meet the challenges of modern day healthcare. Proactive care for these patients now includes escalation to critical care or to palliative care. Replication of this model would be cost neutral for any trust with a critical care outreach team.