Background An integrated approach to care has a positive impact on patient and family wellbeing (Pizzi, 2014. J Allied Health. 43: 212). Access to the hospice multidisciplinary team (MDT) has been readily available to those admitted to the in-patient unit (IPU), while those cared for in the community have had more ad hoc access to the MDT. This highlighted an inequity between those supported at home and those admitted to the hospice IPU.
Aim We wanted to address this inequality in our service, ensuring our community patients receive a holistic MDT approach to their care. With intervention from the whole hospice MDT complementing the clinical nurse specialist service, resulting in improved patient wellbeing and end of life outcomes.
Methods We have introduced an electronic ‘virtual ward’ (Lewis, Vaithianathan, Wright, et al., 2013. Int J Integr Care. 13:1) where patients who have complex symptoms, social or emotional concerns, raising the question ‘I am concerned because...’ are admitted, highlighting the patient to the MDT. Patients are discharged once the concern has stabilised, which is identified by using the Integrated Palliative Care Outcome Scale (IPOS), Phase of Illness (POI) and Australian Karnosfky Performance Scale (AKPS).
Embedding a community physiotherapist in the team enables the delivery of appropriate and responsive physiotherapy plus close collaboration via daily ‘alert ‘ meetings with an Occupational Therapist, Social worker, Doctors, Carers’ support and Spiritual care, all contributing their specialist expertise and knowledge.
Results An integrated community service allows for more responsive patient support from appropriate professionals and therefore better patient outcomes for those in the community setting, offering a more specialised and expert service (Seow & Bainbridge, 2018. J Palliat Med. 21: S37). The effectiveness of this integrated service will be measured through the IPOS, number of patients meeting their preferred place of death and patient and family feedback (Chang, Chung, Tam et al., 2021. BMC Palliat Care. 20(143).
Conclusion Hospice community patients and their carers experience improved outcomes through the development of a ‘virtual ward’ and the introduction of an integrated community team, enabling access to the wider hospice MDT in the community setting.
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