A significant proportion of children surviving meningococcal disease and their parents are likely to suffer psychological stress symptoms to a degree that warrants attention.

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Poster sessions A166Thorax 2012;67(Suppl 2):A1-A204Results 144 individuals died on respiratory wards, median (range) age of 76 (18-96) years with the majority having a length of stay over 8 days. 42 individuals died within 28 days of discharge from a respiratory ward, median (range) age of 71 (42-87) years. The commonest cause of death was pneumonia and lung malignancy for inpatient and post-discharge deaths respectively. 23.8% and 83% of in-patient and post-discharge deaths respectively had documented communication with primary care about a palliative intent to care, the majority of these had a diagnosis of thoracic malignancy. Within the 12 months pre-death all patients had evidence that EoLC may have been appropriate to consider. Conclusions Palliative communication with primary care was made for some individuals, mostly with lung malignancy. This probably reflects more predictable disease trajectory and MDT decisions of "best supportive care". Lack of confidence around predicting terminal disease in other respiratory conditions, particularly those such as COPD which are prone to exacerbations, may account for the differences in rates of communication of palliative care approaches in these disease groups.A key driver for the implementation of high quality EoLC for patients with respiratory disease is recognition of patients approaching the end of life and communication with the individual, family and primary care to ensure that the patient's wishes for EoLC are identified and supported. Background Surveys show most patients want to die at home. However 53% of all UK deaths occur in hospital. Patients with chronic respiratory disease are more likely to die in hospital (66% of COPD deaths) yet hospital end of life care is often poor. Clinicians are advised to use the 'surprise question' to identify patients that need advance care planning (ACP). Do not attempt resuscitation (DNAR) orders (evidence of ACP) are often not completed. Barriers previously identified include: lack of training, time, appropriate opportunity and experience; personal discomfort; and perceived lack of patients'/carers' understanding. Objective We investigated experiences, beliefs and attitudes of doctors in a district general hospital towards end of life care, focusing on issues relevant to Respiratory patients. Methods Clinicians of varying grades were invited to complete a multiple-choice questionnaire during 'Dying Matters Awareness Week 2012'. Results Amongst the 73 doctors (49% male) there was a high degree of confidence (eg 76% agreed or strongly agreed that they were comfortable talking to patients/relatives about death and dying).However this did not correlate with familiarity with the 'surprise question' (23% said they were familiar but only 3% gave a correct response), or knowledge of the most distressing end of life symptom (only 18% identified shortness of breath correctly), or knowledge of the patient group with the highest unmet palliative care needs (only 23% identified patients with Respiratory diseases). 40% believed "pa...

Eight ambulatory Mental Health Settings have been commited in a national pilot intervention aiming at improving the quality of the service they deliver from April 2006 to december 2007. This twenty months intervention allowed teams to set operational bjectives, to describe their organization, to implement an actions’plan and to evaluate their results.The main operational objectives they chose were the following:•Delay for an initial appointment.•Delay for an appointment following a discharge from hospitalization.•Rate of non attendance.The framework to analyse their organisation included a focus on Human ressources, on Operations, on Strategy and on Information Sharing.The main findings were awide variations in performance from a setting to one another (median delay for a first appointment with a psychiatrist ranging from one to seven weeks, paid psychiatrist working time for a single appointment ranging from 0.6 to 2.5 hours...), lack of formalisation of processes (including major processes as intake, discharge from hospital...), the absence of objectives set by the managemers.Actions’plans included very basical actions as setting dashboards and objectives, setting strategy to decrease non attendance, sharing diaries, reorganising meetings, mapping patient’ pathway.Finally, some results were obtained as:•reduction of delays for first appointments (4 settings amongs 8);•reduction of delays for a appointment after hospital discharge (1 amongst 8).Furthermore, this pilot intervention allowed to create and develop tools, method and experience for accompaining other settings. Ten new volunteers are involved since july 2008.