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P25 Transforming day care services across boundaries
  1. Gaberielle Linehan and
  2. Caroline Snow
  1. St Raphael’s Hospice


South of England Hospice, population of 370,000-380.000, 14 inpatient beds and community team supporting approximately 300 patients.

Day care services previously delivered via a care model unchanged in twenty years; all day attendance with no defined focus.

A service review in 2011 demonstrated that on average 33 patients attended over four days from a community case load of approximately 300 (cost £4545.45 per patient). Referrals from the CNS team took on average two to three weeks to be processed to arrange a ‘look around’. Following this 40% of patients were unable to attend due to condition deterioration. A CNS caseload review demonstrated the patient demographic was changing to younger more discerning patients wanting specific treatments for attendance.

Day care services were suspended in May 2012 for a refurbishment project. This allowed a rethink on the parameters of the service, aiming to focus, energise and engage.

Service reopened in October 2012 delivering morning or afternoon sessions each with a specific focus. Lead for day care changed to a therapist with nurse support. Activities include, Hope course, art and craft, yoga, music therapy, bathing service on one afternoon, complimentary therapies, lunch clubs and an information centre once a month for all patients /relatives.

Focus of engagement changed from CNS referral to direct patient contact with a choice in activities. Attendance: STEP 1- three months accessing two sessions weekly plus a lunch club: then STEP 2- choice of one activity monthly and a lunch club. Eliminates need for discharge and allows for ongoing monitoring and engagement with hospice.

In the six months to March 2013 there has been engagement with 89 patients’, representing an increase of 166.8% over the 6 month period reducing the cost per patient to £1685.39.

User feedback is positive and active ongoing service review and development is planned.

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