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36 ‘Spells of care’ could work magic in the community
  1. Janice Penman
  1. Isabel Hospice, UK


Background In palliative care objective measurement of our clinical effectiveness has always been an area of concern. An ongoing ever increasing demand for specialist palliative care community services means that managing caseloads can be a challenge. There is very little literature or evidence of good practice around this important part of specialist community palliative care.

Method The suite of OACC measures were introduced to a hospice community team service to help with caseload management. CNSs began to deliver more short term interventions or spells of care to a patient and their family with the aim of resolving particular problems. A telephone caseload was initiated and this allowed the CNSs to maintain contact with patients with stable symptoms but with the potential to deteriorate. Use of IPOS has defined these spells of care enabling discharge either back to primary care team other supportive hospice services or to the telephone caseload. IPOS also helped us to identify patients in the unstable phase of illness.

Results We have seen a 35% reduction in the average length of time our patients are on a community caseload at the same time as 21% of community patients being managed on a telephone case load. These figures are based on referrals from April 2017 to June 2018.

Conclusion We expect that using spells of care to define caseload size will be a more sustainable way to maintain manageable caseloads in the future. They will also help us to focus more on patients in the unstable phase of illness where most benefit from palliative care services can be expected.


  1. . Witt J, de Wolf-Linder S, Dawkins M, Daveson BA, Higginson IJ, Murtagh FEM. Introducing the outcome assessment and complexity collaborative suite of measures. A Brief Introduction – Version 22015.

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