During a Strategic Away Day in November 2013, the Hospice Nurse Specialist Team (HNST) at Wigan and Leigh Hospice identified the necessity to increase responsiveness to patients’ needs during periods of high demand upon the service, by considering ways of increasing overall efficiency. It was agreed to introduce nurse-led clinics for those patients functionally able to attend the hospice, using the WHO performance status tool for guidance.
The HNST have provided face to face assessments in the homes of their patients for many years. Nurse-led clinics was a significant change in approach to the model of care and challenged the community’s expectations that the community service will only be delivered in patients’ homes.
The HNST comprises of three clusters, each having two nurse specialists and one associate nurse specialist and a team manager. Initially each cluster was allocated one afternoon clinic session with 4 × 45 minute slots per session. The use of the clinic slots was audited and recommendations made.
In the following months there was increase in the flexibility of clinic allocations and an increase in the availability of clinic rooms. There was a greater promotion of nurse led clinics at initial assessments and clusters were reminded to consider clinics during team meetings and at MDT.
A second audit confirmed an increase in the use of nurse led clinic slots:
23/6/14 – 31/12/14 (6 month period) 51 clinic appointments booked (1st audit)
1/6/15 – 31/8/15 (3 month period) 101 clinic appointments booked (2nd audit)
Failure to attend clinic appointments were relatively low at 11%.
Changes in the service model have:
provided patients and their carers with greater accessibility to the HNST
increased responsiveness to needs
given patients more choice about their care provision
patients have expressed that clinics greatly reduced their fears of the hospice environment and services.
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