Background Despite advance care planning, patients with palliative care (PC) needs still attend hospital in crisis. Concern about appropriate environment of care for these patients has led to development of PC services at the hospital front door: e.g., accident and emergency (A&E), acute medical unit (AMU). Exploring this, a new liaison role with AMU was developed at Shrewsbury and Telford Hospital (SATH) whereby the PC team contacted the unit directly for referrals, which were reviewed by the PC consultant.
Aims The aim of our study was to explore the efficacy of PC at the hospital front door via a literature review and compare this with the pilot developed at SATH.
The literature review examined PC services in A&E/AMU. Non-relevant, non-English and duplicate papers were excluded. Papers were scrutinised for service description and patient outcome measures.
Quantitative analysis of the SATH pilot project explored patient population and outcome from referral.
Six relevant papers were retained and analysed in detail. Systematic review proved difficult because of the different methods described. However, results did show an increase in PC consultations and reduced length of hospital stay. One paper showed reduced readmissions to A&E over 30 days.
Over three months at SATH, the new service saw six patients referred to the PC consultant, of which three died during admission. Two of the three discharged patients were referred to the community PC team.
Conclusion Our literature search shows a paucity of published evidence. However, available results demonstrate improvements in patient outcomes. The SATH service analysis shows benefit in terms of discharge planning but is limited by small patient numbers. More research is needed particularly focusing on UK practice and to better define patient outcome measures.
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