Emergency Care Improvement Programme - End of life care project

Hospice UK (formerly The National Council for Palliative Care) Quality Improvement team, in partnership with NHS Improvement and four acute trusts across England have now completed a 12 month programme of work.
Emergency department

The overall aim was to improve the quality of care for patients who may be in their last three months of life who attend or are admitted to hospital in an emergency.

Why was this work needed? Because we know that:

  • People are more likely to be admitted to hospital in an emergency as they get closer towards their last days of life. In 2015, 67% of the total deaths in England (334,073 people) had at least one emergency admission in the last 90 days of life (National End of Life Care Intelligence Network, 2017) 
  • Preferences for care may change and many admissions are not avoidable. They may however be unwanted by the patient and their carer.
  • Hospital costs make up the biggest proportion of costs in end of life. (Nuffield Trust, September 2014)
  • Complexity is increasing, comorbidity is increasing with increased life expectancy. We need new models of care to support the management of clinical uncertainty. "Doctors and the public should be reminded of the inherent uncertainty in the pace of disease progression and that reversible and irreversible conditions can coexist and need to be assessed in the context of the patient’s wishes" (BMA (2016) Volume 3: Reflections and recommendations).

What did we do? We worked together

Using a quality improvement approach, the programme had three distinct phases – understanding the current situation, defining the aim for the project and an action phase. Working with the four clinical teams and our clinical advisory group/faculty we have developed:

What have we learnt?

The programme has been independently evaluated. Based on the success of this programme the Hospice UK team have been commissioned for a second phase by NHS Improvement. We will be working with eight sites over a 12 month period:

  • Royal Cornwall Hospitals NHS Trust
  • St Mary’s Isle of Wight NHS Trust
  • Lewisham and Greenwich NHS Trust
  • North Middlesex University Hospital NHS Trust
  • George Elliott Hospital NHS Trust
  • Ipswich Hospital NHS Trust
  • University Hospitals of Leicester NHS Trust
  • Shrewsbury and Telford Hospital NHS Trust 

Useful Resources:

The Supportive & Palliative Care Indicators Tool (SPICT™)

The Gold Standards Framework Proactive Identification Guidance (PIG)
The National GSF Centre’s guidance for clinicians to support earlier identification ofpatients nearing the end of life leading to improved proactive person-centred care.

The Red Bag scheme for residents in care homes

For More Information

Please contact Amber Morgan, Programmes Coordinator.  

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