Background The hospice community CNS team has piloted a 9–5 service at weekends and bank holidays in response to national guidance and the need for a continuous seven day service for patients with complex palliative care needs at home (NPEoLC Partnership, 2015–2020).
Aims To promote preferred place of care/death, avoid inappropriate hospital admission, promote appropriate hospice admission and provide continuity of care for hospice community patients.
Methods One CNS working on bank holidays and weekends received 52 urgent referrals from the hospice advice line for interventions associated with uncontrolled symptoms, rapid deterioration, emotional distress, and requests for hospice admission. 47/52 received the service of which 36/47 were visited at home.
Results 1. Promote PPC or PPD
Most patients with complex needs who received this service achieved their preferred place of care, 27/32 or 84%.
2. Avoid inappropriate hospital admission
This was achieved as hospital admission was appropriate for 5/5 or 100% who were assessed as requiring treatment from secondary care.
3. Access for appropriate hospice admission
Appropriate admission to the hospice was achieved by 10/12 patients but two were not admitted due to lack of beds. Inappropriate hospice admission was avoided for a further seven patients where 5/7 were supported by this service to stay at home and 2/7 were assessed as requiring hospital admission.
4. Provide continuous care in complexity
CNSs strongly agreed or agreed that the aims of the referral were met for 43/44 or 98% of patients and families who received this service.
Conclusions The results demonstrate positive outcomes of this service in the urgent management of complex symptoms, distress, deterioration and the promotion of PPC. The service criteria is being expanded to address the unmet need of patients who require proactive CNS interventions to sustain palliative care control and avoid crises.