Background and Aims Emergency admissions to hospital increase in the last year of life and can be avoidable (Barbera, Taylor &, Dudgeon, 2010. CMAJ. 182: 563). In 2016 there were over 1.6 million such admissions in the UK, at a cost of £2.5 billion (Marie Curie, 2016). Emergency Department attendance data can be used as a quality indicator for care at the end of life (Earle, Park, Lai, et al., 2003. J Clin Oncol. 21:1133) and early palliative care involvement can reduce length of stay (Jordan, Allsop, ElMokhallalati, et al., 2020. BMC Med. 18:1; Zaborowski, Scheu, Glowacki, et al., 2022. Am J Hosp Palliat Med.). This project aimed to provide daily in-reach into ED at the local teaching hospital to reduce unnecessary admissions, provide responsive and timely palliative care support, and increase the number of patients achieving their preferred place of care/death.
Methods We introduced a dedicated bleep as the main point of contact for ED for support during normal working hours (7.30am - 5.30pm, 7 days). Daily visits and liaison with the nurse in charge identifies suitable patients and promotes the service. Data collected includes any evidence of advance care planning prior to admission e.g., EPaCCS, DNACPR.
Results During 1st Feb 21 - 31st Jan 22 a total of 69 patients were supported. Of those 19 (28%) were discharged back to their place of residence or the local hospice, avoiding admission and reducing length of stay by on average a day, saving 78 bed days. 38 (55%) did not have a completed EPaCCs in place prior to admission. 10 (14.5%) of the patients seen died the same day.
Conclusions A larger number of patients have been seen than anticipated, reflecting current pressures on local health care systems. A significant proportion of patients attending without a DNACPR or EPaCCs highlights the need for further work to promote anticipatory advance care planning. Early specialist palliative care in-reach into ED can prevent unnecessary admissions for patients in their last year of life as well as providing support and education to staff.
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