Development of a holistic admission assessment: an integrated care pathway for the hospice setting

Abstract

This article describes the development of a holistic admission assessment for all inpatients admitted to a 66-bedded hospice, structured in the form of an integrated care pathway (ICP). The need for an improved assessment process was identified by clinical staff, who recognized that the existing assessment was not truly holistic and was dependent on the skills of the assessors. The assessment also lacked appropriate goals and actions. The recently published National Institute for Clinical Excellence (NICE) guidance on Improving Supportive and Palliative Care for Adults with Cancer, has also highlighted key areas for the improvement ofpatient assessment in specialist palliative care (NICE, 2004). Implementation of the ICP has resulted in a systematic and timely holistic assessment process for patients. The ICP addresses effectively the NICE recommendations for the assessment of specialist palliative care patients.

Whole person assessment for family medicine: a systematic review

“…Accordingly, the assessments took various forms, including lists of questions/domains to assess, tools numerically scoring multiple assessment domains, interview guides coupled with visual tools to facilitate patient engagement, patient questionnaires which informed patient–clinician discussion, visual clinical reasoning tools, clinical guidelines or merely suggested approaches and care pathways. Some directly linked assessment to care planning 45–70…”

“…While all included assessments required patient–clinician interaction, many did not describe the context of patient–clinician relationship and it was often unclear whether there was an expectation of pre-existing or ongoing therapeutic relationship. While length (multiple consultations over time) is a feature of WPC in GP, few WPAs were longitudinal 42 45 46 49 54 60 64 65 67 69–72 78 83–86. Most tools developed for primary care, however, assumed both pre-existing and ongoing patient–clinician relationship 43 44 52 53.…”

“…Several were developed from authors’ experience and/or literature,48 49 59 70 76 84 85 87 90–92 and some were adaptations of other tools 41 52–54 61 63 68 78 83 86. Some involved stakeholder input in development: most of these consulted experts,41 43 44 52 56–58 61 62 65 66 72 77 80 89 93 94 with only two describing patient input 43 44 62…”

“…Where stated, the time requirement varied from less than to over an hour (across multiple consultations) 41 43 44 48 53 62 83. Several tools were flexible in content and length depending on patient needs 43–45 49 54 55 61 65 71 73 76 77 79 80 87 92 96–98…”

Modelling Granular Process Flow Information to Reduce Bottlenecks in the Emergency Department

“…This takes on added importance in the case of complex conditions, the type of care that was associated with Majors, making time criticality especially vital since patients must be quickly and accurately diagnosed and placed on correct pathways. Generally, care pathways have been shown to enable timely assessments [122], integrate evidence-based care, and improve the consensus on treatment plans [123]. Nonetheless, evidence suggests that they may be less effective for variable patient journeys [123].…”