Background The aim is to improve the quality of care for patients who may be in their last three months of life who attend or are admitted to hospital in an emergency. Hospitals are an important provider of care for this group of people (Clark et al., 2014). An emergency admission may indicate underlying clinical decline. Quality of experience of care varies (Office for National Statistics., 2015). Acute admission processes are not generally designed to manage care for this group (Bailey et al., 2010). This may result in unwanted inpatient stays and/or treatments (Cardona-Morrell et al., 2016) that affect the person’s quality of (their remaining) life. Detail is important: ‘sometimes, it’s the little things that matter, and that is what you remember’ (NHS Improving Quality., 2014). This is in the background of increasing demographic related demand for palliative care (Public Health England., 2015) and associated pressure on services (Lowthian et al., 2010).
Method Four acute hospital Trusts formed a quality improvement collaborative in 2016 with expert clinical, quality improvement and patient experience advice. The methods to diagnose underlying problems and facilitate acute physician engagement included: a ‘patient/relative’ experience walkthrough, a case file review and analysis of activity data and building on existing plans for improvement/known issues. The Trusts set their own priorities for improvement.
Results The ‘walkthrough’ highlighted areas for improvement, eg information, signage and mortuary visiting environments. The casefile review facilitated acute physician engagement in three Trusts. These highlighted some excellent practice, which was not consistent. Recognition of dying (69% – average three Trusts); recognition clinical uncertainty of recovery (53% average 3 Trusts); non-beneficial treatment (65% average two Trusts). 60% patients who died in hospital had a prior visit to that Trust (three months) – potential missed opportunity to plan.
Conclusions This is an important topic. Results are still emerging including an independent evaluation due in September 2017. Improvements in clinical processes (quality and reliability) depend on good engagement with acute clinicians. Quality improvement methods helped, but other enablers are often required.
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