Background Our Integrated Care Organisation acknowledges that there are patients with life-limiting illnesses who attend the Emergency Department (ED) requiring symptom control without requiring admission to hospital. Our hospice day services have undergone modernisation to provide flexible specialist palliative care. The START Clinic at the hospice can support a timely discharge for those patients wishing to not be admitted to hospital who can be supported in the community. Patients with long term or potential life-limiting illness, including patients with dementia, can be referred.

Aims To provide rapid access to specialist palliative care including medical assessment

To support the patient and family to understand their disease progression/symptom management in order to plan their own care and treatment and potentially reduce the incidence of crisis management and unnecessary re-attendance to ED

To provide support to patients living with dementia and their families in a home or care home setting

To reduce the need for crisis interventions

To reduce the need for unnecessary re-attendance and potential admission to a busy acute hospital environment.

Methods The patient is deemed medically stable and does not require acute inpatient treatment for their condition. Integrated. Assessing clinician in ED rings through referral to START clinic. START clinic contacts patient at earliest opportunity or confirms patient is coming to START from ED if appropriate. Patient assessed in START by appropriate clinicians and treatment plan agreed with patient and carer. Links to community agencies made including telemedicine, social care etc.

Results The project is about to be launched and will be fully evaluated by patient outcomes, changes in patterns of attendance at ED and collecting patient narratives to look at trends in those using the integrated service.

Conclusion Working in partnership we hope to reduce emergency admissions and improve the pathway for patients.