Aspects Early identification of dying patients in hospital setting/Empowerment of hospice nurses/New income from collaborative initiatives/Increased access for patients with non-malignant diagnosis to hospice

Background Many patients do not wish to die in hospital but the majority do. Death in a patients’ usual place of residence is often difficult to achieve because of rapidly increasing care needs particularly for patients who deteriorate as a result of an acute (often non-malignant) illness. Many of these patients would not meet referral criteria to a specialist palliative care hospice bed.

Aim To develop a service allowing patients with generalist palliative care needs to access nurse led hospice end of life care

Approach used Collaborative approach involving CCG, York Foundation Trust and Saint Catherine’s Hospice. Referral criteria, process for identification and assessment of patients developed. Positive engagement from hospice nursing staff with multi-disciplinary team support as required. Pilot period extended to 18 months allowing development of business case for ongoing funding (agreed till 2017)

Outcomes Between 1st Jan 2014–31st December 2014

• 147 patients assessed as suitable for transfer to Nurse Led Bed

• 100 patients transferred to hospice

• 98% of patients seen on day of referral by hospital palliative care team

• 73% of patients transferred to hospice on day of assessment (27% following day)

• 61% of patients had non-malignant diagnosis

• Average length of stay 4.2 days

• >350 hospital bed days saved

Conclusions The nurse led bed service has encouraged hospital teams to identify dying patients earlier, afforded dying patients an alternative choice for end of life care and empowered hospice nursing staff to lead on patient care.

Application to hospice practice Has already been used as a model for similar services elsewhere in the Yorkshire region