Background St Barnabas House Renal Supportive Care (RSC) Service for patients with advanced renal disease (CKD <15) launched in 2016. Model: RSC clinical nurse specialist (CNS) 32 hrs per week; palliative care consultant support within existing community sessions; hospice multidisciplinary team input. Intervention: domiciliary visits, hospice-based outpatient clinics, joint reviews in nurse-led hospital renal clinic, attendance at hospital renal service (HRS) complex patients MDM; symptom control including fluid management; advance care planning (ACP); decision making support regarding treatment modality; Psychosocial support; liaison with community services and HRS.
Methods Service evaluation using system 1 data for patients on RSC caseload April 2016 to August 2019. Identifying successes, challenges and future opportunities.
Results Strengths: Increased access from <1% to 3% of hospice annual referrals, 49% of patients accessed other hospice services; 87% of patients who died, died in a community setting; good feedback from patients; collaborative working with HRS.
Challenges Initial referral criteria included an eGFR <15 and patient‘s choice to pursue conservative management, both have limited value in predicting prognosis or specialist palliative care needs; Patients undergoing dialysis are underrepresented (17%); the traditional model of hospice care - acceptance onto caseload from referral until death, is less relevant in this group; unclear monitoring/prescribing responsibilities for renal specific symptoms - diuretics, anaemia and electrolytes; lack of a supportive care register or clinical lead for HRS.
Opportunities Modification of referral criteria - needs rather than diagnosis based; modification of service model to deliver care in episodes; further collaboration with HRS - shared symptom scale, clearer shared care responsibilities.
Conclusions The RSC service at StBH has increased access to specialist palliative care for people with advanced renal disease. However the described challenges could negatively impact a sustainable and safe service as referral numbers increase. We have identified and are implementing solutions working collaboratively with the HRS.
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