Case study:

11 May 2010

Implementing the Gold Standards Framework (GSF) in palliative and end of life care within an out of hours (OOH) and ambulance service in West Hampshire

---

Key points

---

More than three quarters of patients with palliative care needs are dying in their preferred place of care since the GSF was implemented in West Hampshire’s out of hours service, an audit suggests.

The GSF is helping to provide a more seamless service.

Communication has improved between all involved in the care of patients in the final year of life.

The West Hampshire Out of Hours Service, which provides services to around 200 GP surgeries, is co-located with South Central Ambulance Service (Hampshire Division) in their emergency operations control.

As a result some carers were confused about which service they should be contacting in a crisis.

Often this led to an ambulance being dispatched to a terminally ill patient, and for various reasons the patient was either resuscitated inappropriately or was taken to hospital where they died an undignified death.

Southampton City PCT began to introduce the GSF principles into the service in 2006 with the aim of:

Reducing unnecessary 999 callsReducing unnecessary hospital admissionsReducing inappropriate resuscitation attemptsImproving interaction with relatives and carersImproving handling of patients

The OOH service has now developed a reporting system, which is completed by the general practice.

The form holds comprehensive details of the patient, their diagnosis, treatment plans and medication.

The details are stored on the OOH and ambulance computer systems in the emergency operations centre.

If the OOH service receives a call for a patient with these special notes, the call handler immediately notifies a qualified nurse.

The nurse is then able to advise the caller of the appropriate action.

If this involves a visit by a healthcare professional the relevant information, including the patient’s preferred wishes, can be passed to them electronically.

If a caller rings 999 for an ambulance, a qualified nurse will monitor the call.

Following an assessment the nurse will arrange for a suitably qualified healthcare professional to attend.

This may not necessarily be an ambulance.

Improved pain control and the wider availability of ‘just in case’ boxes also enables quicker access to medicines which are written up prior to being needed and kept in the patient’s home.

In addition regular meetings are held with the gold standards facilitators where information is exchanged and cases reviewed.

Representatives on this group then share information with practices in their area.

Whenever a call is received to a vulnerable patient for whom there is no care plan, a letter is sent to the patient’s GP to request further information.

If three calls are received in a week for the same patient or eight calls in a month, then the patient’s GP is informed and a review requested of the patient’s needs.

An audit of 50 patients between November 2006 and April 2007 showed that 94% wanted to die at home and 6% in the local hospice.

In fact 72% died at home, 18% in the hospice and 10% in hospital.

Of the six patients who died in a hospice rather than their preferred place of death, all six were admitted for symptom control.

Of the five patients who died in hospital, one patient was taken to A&E and another to a local medical assessment unit because of communication errors.

Of the remaining three patients, all were admitted because of new problems unrelated to their terminal illness.

This small sample shows that the service’s aims and patient’s choice are in most cases being met.

But more needs to be done to improve the service further.

---

Back to top