In recent years attendances to the emergency department (ED), and consequently patient waiting times have skyrocketed. This combined with increasingly stretched community services has led to growing numbers of patients presenting at end of life (EOL) and dying in ED. ED staff describe huge dissatisfaction in their ability to provide good end of life care to patients in the department. A big factor in this is the lack of ability to rapidly discharge a patient from ED to die in a more appropriate setting. In May 2023 a Macmillan funded Specialist Palliative Care Practitioner role (band 7 specialist nurse) was created with the aim of improving the experience of patients at EOL, increase the early identification of patients in the dying phase, change departmental culture, provide education and reduce the number of deaths within the department.

The practitioner worked closely with the regional Ambulance Trust, the hospital Frailty Team and Medical Assessment Unit and was based full time Monday – Friday in the ED. The role was patient both patient facing and strategic, with the aim of developing processes to reduce time spent in ED for EOL patients and improve discharge processes.

Early data has shown a hugely positive impact from the role. In the first 21 weeks 99 patients were reviewed; of these 76 had Treatment Escalation Plan (TEP) documents updated, 6 died in ED with support from the post holder, 24 were admitted to hospital and 64 potential acute potential admissions were avoided and instead successfully discharge to their own home, nursing home or hospice directly from ED.

The joint role of having a specialist palliative practitioner embedded in ED has been hugely successful so far and the Hospital Trust is now looking to expand the role further to provide a 7 day service to support pre-conveyance decision making.