Acute palliative care in the assessment areas

Abstract

Aim To describe the benefits of early review by the Hospital Palliative Care Team (HPCT) for acutely admitted palliative patients. Background Over an 18 month period, the HPCT at a large University Hospital have attended the Medical Admissions Unit on a daily basis to pick up known patients and new referrals to the service, in order to provide early symptom control advice, to advise on appropriate treatment plans, and to begin early discharge planning for potentially complex patients. They have attended post-take ward rounds and introduced targeted palliative care teaching sessions within the Acute Assessment Areas. An electronic flagging system to alert both the admitting team and the HPCT of a patient's palliative status has also been trialled. Methods A retrospective audit of a 1 month period prior to implementation of this service was compared to the results of a similar audit performed 18 months following implementation. Results Prior to implementation, only 5% of patients referred to the team were identified in the Assessment Areas. The median total length of stay was 10 days, and on average patients were referred on day 5, half way through their admission. Following implementation, on average 25% of all referrals came from the assessment wards, all of whom were seen within 24 h of admission. Total new referrals to the team have increased by over 50%, suggesting the intervention helped to identify patients who would otherwise not have been referred. (Graphical representation of these results). Conclusion The service is felt to be of benefit by both the staff in the Assessment Areas and the HPCT, improving early access to services and advice for palliative patients, and improving clinical relationships. Further work is on-going to quantify any improvement in discharge outcomes for patients, including place of discharge and average length of hospital stay.