Short-stay, specialist beds in a UK teaching hospital as a model to integrate palliative care into the acute hospital culture ABSTRACT Hospital patients should have access to effective palliative care. In our study, three short-stay beds were re-allocated to specialist palliative care as part of a pilot programme. This paper describes the first 100 admissions of patients with inadequately controlled symptoms or distress. Median pain and distress scores were both seven out of a maximum of 10 (interquartile ranges [IQR] 4-10 and 1-10 respectively), reducing to 3.5 (IQR 1-5) and 0 (0-5) after 48 hours. Median length of stay was five days (IQR 3-10); 77% of patients were discharged: 32% to home, 26% to a hospice or community hospital, 19% to their original ward for treatment and 23% died in the unit. A unit education programme introduced as part of the study attracted 600 staff members. Pain and distress were rapidly improved by brief, intense palliative care in a small onsite facility. The pilot programme also influenced the understanding of palliative care in the hospital, demonstrating what it offered patients, family and staff. It demonstrated effective, concurrent working alongside an active disease-management approach, and encouraged collaborative discussions about the goals of care.
Objective To create a culture in an acute hospital where palliative care is more understood. At a strategic level hospitals accept the need to provide palliative care which is integrated with other hospital activity. It is however, often difficult at ward level to achieve this, especially in addition to ‘active’ medical treatment. Our advisory palliative care service began in 1998. We now report the benefits of a pilot (2009–10) Acute Palliative Care Unit (APCU) which has now achieved NHS funding. Pilot Acute Palliative Care Unit: Three single rooms in an acute surgical ward •7.6 seconded nurses some with Specialist Palliative Care experience •1.0 Consultant for the APCU and Ninewells advisory service •0.6 Consultant to run an education programme. Admissions Patients seen by the advisory service with the most complex symptoms or needs. Data Prospective collection: daily ESAS and distress scores; percentage of patients seeing appropriate disciplines within 2 working days; family meeting; discharge outcome; satisfaction (patient, family and staff). Results 100 patients were admitted in the first 11 months. Pain was reduced from a median of 7 (IQR 5–10) on admission to 3.5 (IQR 1–5) within 48 h; distress from 7 (IQR 1–10) to 0 (IQR 0–5) within 48 h. There was no significant increase in any symptom (paired t test or Wilcoxon Matched-Pairs Signed Ranks Test). Median length of stay was 5 days (IQR 3–10) and mortality (23%) was low for a palliative care setting. 77% of patients were discharged directly from the unit: 32% home; 26% hospice or community hospital; and 19% to their original ward for active treatment or further consideration of active treatment. Discussion Seeing specialist palliative care practiced effectively in an acute surgical ward initially intrigued medical and nursing staff but it also encouraged an understanding of each others' disciplines and promoted collaborative working.
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