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Abstract
Background Clinical Nurse Specialist (CNS) teams, operating across multiple sites, encountered challenges in managing individual caseloads. This led to inflexibility at a time of increasing demands and staffing shortages. A redesign of the service delivery model was sought to improve team responsiveness and availability of peer support, to meet the projected growing demand for complex palliative care in Scotland (Finucane, Bone, Etkind, et al. BMJ Open. 2021;11(2):e041317).
Aim To implement a shared caseload management approach to ensure continuity of practice, increased flexibility, efficiency, and peer support.
Method/Actions
Local CNS Teams (Chaddock, Gray, Crichton, et al. BMJ Support Palliat Care 2023;13:A24) were reviewed, in relation to services delivered, staffing resources, and access times, to assess suitability for our service.
A continuous improvement approach with whole team ownership was employed.
Method/ActionsThe following actions were taken:
Updated Service Level Agreement to highlight change of ownership from individual CNS to Band 7 Clinical Leads.
Review of the holistic assessment templates, within hospice electronic patient records, to ensure consistency of assessment and documentation.
Introduction of a whole team morning huddle to ensure consistency and equity of daily CNS workload.
Introduction of a three–week induction programme for new staff, with clear mentorship and goal setting.
Implementation of regular workshops to review and refine processes.
Implemented alongside Hospice Single Point of Access (responsible for triaging patient referrals).
Results Initial data shows patients who died within 1 month of referral received increased episodes of care (average 2022 = 20, 2023 = 28). Time between referral and receiving care also improved (median 2022 = 3 days, 2023 = 1 day). Feedback from staff workshops highlighted increased team working and support in managing complex patients.
Conclusion This new shared caseload model has shown increased flexibility and responsiveness to patient needs, as well as greater staff resilience, making the service well placed to meet the organisational 5-year strategy to increase the number of people we directly support.