End of life care scheme proves a success

A scheme piloting the introduction of an end-of-life discharge sister post has proved successful for patients, Teesside University has found.

The results fit into the key themes the Government is aiming for come – increasing patient choice, involvement in decision making about their care and keeping inappropriate emergency admission and readmissions down such as those at the end of life.

Current costs of end-of-life care lack value for money according to the palliative care funding review by Tom Hughes-Hallet, former chief executive of Marie Curie Cancer Care – and the patient choice agenda has identified that more people wish to be cared for and die at home.

Dr Sharon Hamilton and Susan Jones, researchers in the Health and Social Care research institute at Teesside University, assessed the introduction of an end of life discharge sister at James Cook University Hospital in Middlesbrough. During the service’s first 12 months, 111 dying patients were discharged home.

The increased level of co-ordination by the role helped overcome the problem of having limited time in which to arrange the transfer from hospital. They presented their findings at the Royal College of Nursing International research conference.

Susan said: 'James Cook Hospital wanted to enable more people to die away from the hospital, perhaps in their own home or care home, if they wished to do so. A key finding of the research was how small the window of opportunity was for achieving a good end-of-life discharge. It starts with timely communication with patients and families on the preferred place of care to co-ordinating the rapid transfer from hospital.'

Dr Alex Nicholson, Consultant in Palliative Medicine at The James Cook University Hospital, who devised the pilot said: 'I was very grateful that Macmillan Cancer Support agreed to fund this two year pilot. I am also delighted that the Trust has recognised the value of this work and agreed to support us in carrying it forward. We still have much to do to enable doctors and nurses to recognise when patients are reaching the end of life so that we can have the conversations with these patients to make sure they are cared for where they want to be.'

The Hughes-Hallet review suggests freeing up costs in hospital will enable these resources to be used in the community at no extra overall cost, while meeting the agenda of patient choice and better service.

Susan adds: 'Dying Matters, the national organisation, has found that doctors are not confident in these issues and we found that if the discharge process suffers an initial delay, it will not achieve the speed necessary to get patients home. The newly increased capacity in the specialist palliative care team, resulting from evidence from the evaluation of this new role, allows a fast track discharge for more patients.

'The pilot scheme has seen the production of documents and methods to help people understand the sequence of events that need to be carried out. This is one way that the inequality found by the Hughes-Hallet report can be addressed.'

'Acute beds in hospital are a hugely expensive resource and this model is more tailored and patient centred. Given the issues which are being taken up nationally, it means we are ahead of the curve on Teesside with this scheme.'

'Our next step needs to be researching nursing and medical decision-making around starting discussions around end-of-life decisions sooner, ahead of commencing people on the end of life care pathway and not just in their final few days.'

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