Background In England, achieving a person’s preferred place of death is a national priority (NHS. The NHS Long Term Plan [Internet]; 2019). Proactive identification and planning can result in improved end-of-life care, an increased number of people dying in their preferred place of death, and a reduction in hospital bed days (The Gold Standards Framework International. The Gold Standards Framework: Everyone deserves Gold Standard end of life care [Internet]; 2024). Last July, the local acute trust and hospice collaborated and were awarded funding for an embedded fellowship from the Norfolk Initiative for Coastal and rural Health Equalities to improve the end-of-life care pathway across West Norfolk Geographic place.

Aim To improve the quality of end-of-life care by identifying and achieving preferred place of death in an acute setting.

Method Initially the project involved formal and informal education and modelling. This was embedded in clinical practice to upskill generalist ward staff and the End-of-Life Discharge Co-Ordinator in recognising dying patients and building confidence to initiate conversations about approaching death. Education was formally offered through Quality End of Life Care for All (Gillett, Bryan. BMJ Support Palliat Care. 2016;6(2):225–30), n=14 participants and n=6 participants of Gold Standards Framework (GSF) training. Parallel to this was partnership working between the local hospital and hospice to prioritise GSF Red patients. This included service evaluation of barriers and enablers by jointly working with key stakeholders to achieve rapid discharge at end-of-life. Data was collected monthly for 12 months on preferred place of death achieved and qualitative feedback from staff and patients.

Emerging results

• Improvement in preferred place of death achievement rates.

• Reduction in bed days.

• Development of dedicated End–of–Life Discharge Coordinator role.

Emerging resultsFurther evaluation will be carried out during 2024.

Conclusion This project has enabled closer, sustainable, working relationships between the acute hospital and the hospice which demonstrates the value in system collaboration in transforming the patient journey at end-of-life. The ‘embedded’ nature of the project has built new opportunities to forge stronger, more collegiate ways of working to enable better outcomes at end-of-life.