Background The End of Life Care strategy recommended the delivery of high quality services for patients needing palliative care, access to rapid, specialist advice and clinical assessment (Department of Health, 2008).
Clinics run by Clinical Nurse Specialists (CNSs) are at the forefront of modernising the health service and ensuring that CNSs have the ability to influence and lead in advanced practice. There is a paucity of evidence to support such clinics in palliative care, however, feedback from patients and families tell us they are interested in attending local outpatient clinics.
Aim As part of the hospice strategy to reach more people, a project to deliver local outpatient clinics was developed with the aim of improving efficiency and coordination of services in our community.
Method Four outpatient clinics were established across the hospice’s catchment area, led by the Nurse Consultant. Good working relationships with local General Practitioners and commissioners allowed for the provision of the clinic space.
Results There was some initial resistance. However, increased choice for patients, improved multi-professional working with primary healthcare professionals, and reducing the CNSs workload has supported the development of outpatient clinics.
42% patients remained on the outpatient clinics caseload, 53% were referred on to the Hospice at Home team, 2% attended Day services and 3% were discharged.
7% had a non-cancer diagnosis, this may reflect the lateness of referrals, and are too unwell to attend outpatient clinics.
Medication changes were recommended in 60% of patients, Advance Care Planning with 93% and liaison with acute services in 60% of patients.
Conclusions Outpatient clinics can alleviate pressure on the CNS team, set the direction of travel for patients as well as proactively managing patients’ concerns, symptoms and future plans.
On-going evaluation will continue to demonstrate how these clinics can be developed to support the challenges faced with increased demand on limited resources.
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