Background In November 2021, the local integrated care systems identified a gap in responsive palliative care needs at home, to prevent inappropriate hospital admission. This gap had been exacerbated by reduced capacity, system pressures, and heightened demand (NHS England. Winter resilience. [Internet], Winter 2021 (Cited 2022 May 10). Phyllis Tuckwell responded with a pilot between 06.12.21 to 06.03.22.
Aims To establish and evaluate a responsive service for patients with advanced and terminal illness, presenting with rapidly changing needs and instability at home. The aims were - in line with palliative care ‘Ambitions’ (National Palliative and End of Life Care Partnership, 2021) - to expedite access to assessment and expertise, provide responsive symptom control, support complex decision making and planning at the end of life, access to care, facilitate confidence and trust, advise on practical measures e.g. equipment, reduce pressures on system partners, support preferred place of death.
Methods Funding was sourced, staff redeployed, processes and data collection systems established. Service modifications were influenced by frequent feedback and use of PDSA (NHS England and NHS Improvement. Plan do study act (PDSA) cycles model for improvement. [Internet]. Cited 2022 May 10). Data collection involved patients supported, number of visits and telephone calls; response speed; intervention; impact; case vignettes, and stakeholder feedback to reflect the benefit to system capacity.
Patients supported = 466, with 75% of these responded to within < 2 hours.
Responsive multi-professional interventions included holistic assessment, symptom management, prescribing, medicine administration, advance care planning and ReSPECT discussions, complex decision making, functional assessments, skilled compassionate communication, giving confidence to care at home.
Outcomes Reduced need for visits from other health and care professionals e.g. GPs, DNs, supported hospital discharge, avoided inappropriate admission to hospital and facilitated patient death according to wishes. 18 case vignettes recorded examples of these outcomes and quality of care.
Conclusion The project enabled timely access to palliative care, alleviating pressures on partners in line with aims. Unanticipated benefits were improvements to multi-professional working and reports of role satisfaction. System benefits resulted in funding to substantiate the pilot.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.