Background In November 2019 A Macmillan funded QI project was commenced within the Emergency floor of the University hospitals of Leicester. Aiming to improve the experience and care of patients with an uncertain recovery, palliative/end of life care needs or at risk of dying in hospital. This followed evidence collected from the End of Life Hospital Improvement Programme (ELCHIP) which the trust embarked on following a CQC inspection. Previous proactive Input from Specialist palliative care to the Medical Admissions unit in 2015/16 had demonstrated benefit to patients and staff early in admission.
Method(s) 2 band 7 CNS’s created the Specialist Palliative and End of Life Timely Intervention Project (SPELTIP) to deliver a proactive model providing a dedicated service to patients following an emergency admission. A data collection tool was used to assess the timing and impact of their interventions with patients. This tool included the use of the majority of the Outcome Assessment and Complexity Collaborative measures (OACC). Patients were identified through existing IT systems and tools such as the Clinical Frailty Score alongside an improved referral process. A training needs analysis (anonymous on-line questionnaire to all staff groups) identified staff education training needs and innovative training packages were created and delivered. Adaptations were made during the pandemic.
Results Increased knowledge, confidence and skills in staff ,assessed by receiving formal feedback, increased referrals to palliative care (by 33% in first 3 months), reduced length of stay with a monthly average 50% of pts seen not being admitted to main hospital flow. Admission avoidance and rapid discharges facilitated where community teams had capacity to accept. OACC used to evidence the complexity of patients seen by this route.
Conclusion(s) Patients benefitted from early palliative care input, with symptom management and length of stay being improved. The role became permanent in May 2022 after a successful business case submission, and support has been provided to other trusts to develop a similar care model.
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