Background Nottinghamshire Hospice’s day therapy unit closed its doors to patients during the COVID-19 pandemic. Government advice was supporting discharge from hospital wherever possible (NHS England and NHS Improvement, 2020). When asked, more than four in five people say they would prefer to die at home (Hoare, Morris, Kelly, et al., 2015). Patients receiving care from specialist palliative care teams tend to do better than those without (Higginson & Evans, 2010).
Aims To expedite the discharge of patients at end-of-life from hospital and prevent unnecessary hospital admission for those in the community so that more people achieve their preferred place of death (PPD) with the provision of a dedicated palliative care service.
Methods March-May 2020: consultations with fast track continuing care (FTCC), model planning, internal consultation, workforce transformation. May-July 2020: recruitment, service launch. July-March 2021: continuous service provision. We worked closely alongside FTCC to support patients either in hospital that wished to come home but needed a package of care or, patients that were deteriorating at home and required end-of-life care. An initial assessment by a registered nurse from the Hospice Outreach Discharge Support (HODS) team meant more timely referral into extended palliative community services including provision of specialist equipment and access to other hospice services e.g. bereavement support. It also focuses on the completion of EPaCCS and ReSPECT forms identifying PPD.
Results Number of patients treated by HODS May 20 – March 21 = 195.
64% (124) died at home.
23% (44) remained well enough to be discharged to domiciliary care agency.
10% (20) admitted to hospital.
3% (6) admitted to nursing home.
Average length of stay on HODS = 10 days
PPD achieved = 95.87% 
Conclusion The creation of HODS allows more people at end-of-life to remain in their PPD and with greater access to support services preventing carer burnout and unnecessary admission to hospital.
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