Aims A third of hospital patients are in their last year of life, yet approximately 12% are seen by specialist palliative care leaving generalists to care for 88% of patients. Generalists need to be enabled to provide good palliative care for their patients. The transition from reactive to proactive care by earlier recognition and assessment of personal needs ensures patients receive better coordinated care in a place and manner of their choosing.
Gold Standards Framework (GSF) is a quality improvement programme delivering proactive person-centred care for people in the last years of life in all settings. We report on the introduction and impact of the GSF Acute Hospitals training Programme, with findings from the 12 whole hospital programmes and accredited wards.
Method The structured two year GSF Hospital training programme includes training, tools, support and evaluation at organisational, patient and staff level, including measures of progress and attainment. The programme is delivered to the whole hospital (commissioned) or individual wards (open). GSF encourages teams to identify patients earlier (aiming for the 30% figure where appropriate), assess their needs (offering all initial advance care planning discussions) and proactively planning care aligned to preferences, enabling more to die at home if that is their wish.
Results Evaluations indicate significant progress in several key areas in many hospitals and a ‘culture change’ on the wards. GSF Accredited wards show embedded good practice including earlier identification (average 34%), more proactive needs-based approach, more offered advance care planning discussions (76%–87%), better communication with GPs, reduced hospitalisation and improved more appropriate referrals to palliative care specialists.
Conclusions Findings from the GSF trained hospitals and accredited wards show significant changes, with proactive, better coordinated, person-centred care. A key factor is earlier recognition and accredited wards are able to demonstrate they are identifying 30% of patients.
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