Background As part of the drive to reduce patients dying in hospital a rapid discharge at end of life task and finish group with multi-agency participation was established in 2010 in a large district general hospital in North West England. The aim of the group was to set up seamless pathways of care for patients at end of life who choose not to die in hospital.
Method The group met monthly and identified barriers to discharge. These included lack of identification of end of life and consequent lack of discussion with patients and their relatives, limited use of Liverpool Care Pathway, difficulty in accessing equipment and care provision, limited communication with primary care, delays in obtaining medication and transport. These were compounded by delays in obtaining continuing care funding. Solutions to these barriers will be described.
Results From April 2010 to March 2011, 92 patients were discharged from hospital to their own home or to a nursing home depending on their preference. Seventy-four (deemed to have a prognosis of less than 4 weeks) were discharged within 24 h. The remaining 18 were felt to have a prognosis of hours to days and were discharged within 4 h. All received continuing care funding and were supported to die in their preferred place of care. Feedback from patients and relatives has been positive.
Conclusion The authors have demonstrated that it is possible to meet patients and relatives wishes for preferred place of care at end of life through the use of our rapid discharge pathway. The first year highlighted the need to ensure that all patients are discharged with appropriate supplies of as-required medication for symptom control to prevent crises at home. We have recently launched a printed version of the Pathway with documentation to support multi-agency working and will be auditing its use.
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