Case study:

17 August 2007

Supportive care pathway – an integrated care pathway for inpatients with life limiting illness in the Pan Birmingham Palliative Care Network

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Key points

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The Pan Birmingham Palliative Care Network has introduced a hospital-based supportive care pathway (SCP) in South Birmingham for all inpatients with advanced illness, including those in the terminal phase.

So far more than 100 elderly patients in an acute trust and a community hospital have been cared for using the new pathway.

Staff say the pathway is simple and easy to complete.

They also report it makes them think more holistically about these patients because it prompts them to address every aspect of care proactively, rather than addressing troublesome symptoms reactively.

There had been concern in the Pan Birmingham Network that focusing only on the terminal phase of life meant the wider group of patients with supportive or palliative care needs might not benefit from the same quality of care.

In particular, it was felt older people or those dying of non-malignant disease, particularly dementia, were missing out.

A local survey, undertaken before the SCP was introduced, showed that around a quarter of patients with palliative care needs were looked after on general wards, with cancer or non-cancer diagnosis.

However, only a minority were seen by specialist palliative care services.

The SCP is used by all members of the interdisciplinary team and is the only clinical record for the patient.

This minimises duplication of documentation and improves written communication between members of the clinical teams.

The introduction of the pathway has been complemented by education sessions and a resource pack.

Using the pathway helps staff focus on communication, symptom control and advance care planning for the end of that patient’s life.

But it does not mean the end of all active treatment.

All forms of treatment may still be appropriate if the aim is to address an acute problem to allow the patient to go home.

However, it is an acknowledgement that the patient is moving towards the end of their life.

Frontline staff have been involved from the outset in the design of the pathway, with major contributions from a local clinical champion, a junior doctor and nurses who were involved in the early pilot work.

The perceived value of the pathway has led to its adoption in other care settings, including care homes, other hospitals and an NHS continuing care unit.

There is also interest from other settings ranging from hospices to ITU.

Some staff were initially resistant to the new pathway because they feared it would mean ‘more paperwork’.

This has meant the SCP has had to be introduced gradually with staff being reassured that the new pathway becomes the patient’s clinical record rather than a parallel document.

Some consultants and senior nurses were also initially reluctant to allow the SCP to be used in their areas.

But most have now been persuaded of its value. Ward-based champions and active facilitation have helped to minimise any opposition.

Formal research is underway to assess the effect of the SCP on quality of care and care outcomes.

But an audit demonstrated marked improvements in documentation.

Almost 20% patients have been discharged from hospital while on the pathway.

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