Background Patients in the community setting wishing to be cared for and die at home often end up in the A&E department. Primary responders to patients are usually the ambulance services. The reasons for this are varied but access to specialist palliative care support has been shown to be effective at reducing A&E attendance.The project aimed to improve the knowledge of staff, within the Local Ambulance Service (LAS), focusing on identifying when a patient is dying and what alternative support is available.

Aims

• Increase knowledge to identify dying patient and support available

• Reduce hospital attendance particularly at End of Life (EoL)

• Achieve Preferred Place of Care for patients

• Develop further partnership working.

Approach Hospice staff in conjunction with LAS leads set up three evening training sessions for LAS staff. Sessions covered the services provided by the hospice, symptom control, palliative care emergencies, identification of dying and encouraged crews to “pick up the phone” for advice. Each session was planned for two hours allowing ample opportunity for discussion.

Outcomes Anonymous feedback was obtained from the 55 attendees:

• 100% reported they now feel more confident in dealing with patients at EoL

• 100% identified they feel more confident to call the 24 hour hospice on call service as and when they need advice.

Frequent comments:

• Being able to identify when a patient is dying was most helpful

• Realised that advice available is not restricted to patients known to the hospice.

Conclusion Knowledge has improved with crews recognising patients at end-of-life and contacting the hospice on call service appropriately. Patient choice has been supported ensuring that their Preferred Place of Care at end-of-life is met. Partnership working has improved with further training sessions planned across the county.