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Abstract
Background It is vital that organisations delivering palliative and end of life care demonstrate the difference their work makes. This project emerged from a community nursing service team wanting to improve how they tell the story about their impact. Staff already routinely record a range of data, for example, open text visit summary notes and handover notes. In this initial phase, it was agreed it would be prudent to assess what existing data can tell us about routes to impact.
Aims
Assess the suitability of the case note methodology to evidence impact in two Hospice at Home services in the South West of England.
Describe the routes to impact for patients, the people close to them and the wider system.
Methods Design: a criterion-based retrospective case note review (Hutchinson, Coster, Cooper, et al. Health Technol Assess 2010;14(10)). The coding framework was informed by previous case review projects, as well as Marie Curie’s Impact Framework (Finucane, Swenson, MacArtney, et al. BMC Palliat Care. 2021;20(1):18; Weetman, Dale, Mitchell, et al. BMC Palliat Care. 2022;21(1):155; Bonnar. BMJ Support Palliat Care. 2023;13:A91).
Based on existing evidence and factors such as service population size, 120 randomly selected records from between Jan-May 2023 were reviewed. Patient records were stored on EMIS. Approvals for the project were received by the organisational Caldicott Guardian and Senior Information Risk Owner.
Results Evidence of impact was observed within the case notes. Areas of impact included enhancing dignity and respect, decreasing anxiety for people close to the patient, enabling carers to better cope, maintain preferred place of care and death, and crisis prevention.
Conclusions Existing case notes can contribute towards a body of evidence about the impact for these Hospice at Home services. The analysis is particularly useful for providing a narrative context for impact. There are limitations, such as reliance on record completeness and accuracy. Findings should be triangulated with other data sources.