Background Early palliative care improves quality of life, survival, clinical outcomes, mood and healthcare satisfaction in patients. Our historical offer of a day care wellbeing service to patients with a predominately social focused model required a Quality Improvement programme as the hospice had evolved and patients’ complexity increased.
Aims To implement an innovative approach to outpatient care offered with a focus on patients’ goals, living/dying well and personalised care.
Methods Quality improvement project and process evaluation of the current day care offer. Establish the feasibility of implementing two pathways – health and social – with flexibility for attendance, social prescribing and carer support. The health pathway to be patient goal focused led with a clinical overview from Advanced Care Practitioner and therapists. Triaged patients are allocated key workers (Registered Nurse, Therapist or Advanced Care Practitioner), to facilitate the achievement of the patient’s goals. There are a number of innovative aspects to the new model including the collaboration of the hospice and wider community, introduction of Goal attainment scores, clinical triage, early hospice enrolment, 24/7 advice and support and involvement/offer of intervention for the patient’s main carer.
Results The quality improvement programme is currently ongoing and therefore not all the data is available to date. Early indications demonstrate an improvement to care being delivered that is individualising to the patient. This is being achieved through patient specific goals-setting that are developed and led by the patient. The personalised approach has started to show improvements to the patients’ quality of life, living to live rather than die. Quantitative and qualitative outcome measures are being collected.
Conclusions A systematic patient goal focused care delivery approach including the multidisciplinary team enhances the patient outcome measures within the hospice. Social support is essential to support carers and is a pivotal part of the offer to improve the quality of care delivered and social prescribing. Further extension of this quality improvement plan for the outpatients model are to develop an Integrated Palliative and End of Life coordination centre working with and building links with primary care and community services for patients with a life-limiting illness. These developments will enable us to promote patient-centered care through goal setting and work in conjunction with other partners at Place. Further developments would be to extend the offer and combine other initiatives to support patients in the right place and the right time by the right professional.
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