Background St Barnabas House launched a Renal Supportive Care (RSC) Service in April 2016. This consists of a RSC Clinical Nurse Specialist (CNS), consultant support and joint working with the local secondary care renal team. Since 2016, 110 patients with advance renal disease (CKD 5) have been referred to our RSC service, approximately 3% of the hospice’s total referrals each year from a baseline of <1%. We audited the service to measure impact and inform ongoing service development.
Methods We performed a retrospective audit of system 1 data and data prospectively collected by the RSC CNS for patients on the RSC caseload between April 2016 to August 2019. Data included referral source, reason, duration, outcome and information regarding intervention, advance care planning (ACP) and place of death.
Results 139 referrals were received for 110 patients. Mean duration of referral was 105 days range (1–1103). Referrals were made for symptom control (42%), ACP (39%), Psychosocial support (13%), decision making support - dialysis versus conservative care (6%) and stopping dialysis (2%), patients imminently dying were referred to the non-disease specific CNS team. 49% of patients accessed another hospice service eg Day Hospice in addition to RSC CNS input. Face-to-face patient contacts occurred in patient‘s homes (83%), outpatients (16%) and hospital (1%). 66 patients were discharged following a completed care episode, 29 of these were re-referred. 52 patients died, 38 (73%) had their preferred place of death (PPD) recorded prior to death. In this group 1 (3%) died in hospital. The rate of hospital death increased to 46% (6 out of 14) in patients without a documented PPD.
Conclusions The RSC service at StBH has increased access to specialist palliative care for people with advanced renal disease. Participation in ACP for these patients increased the likelihood of achieving a death outside of hospital.
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