Contacts
Contact:
Dr Charles Daniels
Medical Director
Organisation:
St Luke’s Hospice
Macmillan Consultant in Palliative Medicine Harrow PCT United Kingdom
Tel:
020 8382 8001
Email:
Case study:
11 May 2010
Integrated Out of Hours (OOH) Primary Care Palliative Care Project at Harmoni Community
Key points
- An out of hours palliative care project is providing patients and carers in north west London with comprehensive support in their own homes
- Since the project began hospital transfers have dropped to 2%
- Because of anticipatory care planning most patients do not in the end need an out of hours provider.
A new primary care out of hours project is ensuring palliative care patients and carers in north west London receive comprehensive support in their own homes.
An evaluation of the pilot scheme six months after it began shows that the number of patients transferred to hospital has dropped to 2% and 88% of calls were answered within the required response time.
In addition all required drugs were available when needed, including controlled drugs. The anticipatory care planning also meant that four out of five patients did not in the end require the services of the out of hours provider.
The new service – funded in part by the strategic health authority – was set up to cut unnecessary hospital admissions, reduce lengths of stay and ensure that patients were able to die where they wanted.
In the past handover to out of hours doctors was poor, largely because it relied on GPs who were not always aware of the most recent change in a patient’s condition.
By creating a palliative care handover form and agreeing it could be completed by the healthcare professional most familiar with the patient’s condition, communication improved significantly.
OOH providers were also able to make this information available to any doctor requiring it 24 hours a day.
And they were given a palliative care bypass phone number that allowed carers or staff direct access to rapid medical help in a crisis.
A standard was agreed for the response time from call to medical visit.
In addition the project involved developing symptom control guidelines and a palliative care formulary to be carried by all visiting doctors as well as ensuring pharmacies could provide controlled drugs and oxygen at all times.
The hospice’s 24-hour telephone advice line was more widely publicised and mandatory training in care of the dying and symptom control was introduced for all OOH visiting doctors.
Although the project has been time-consuming, clinicians were so desperate for help that the project has gained clinical support very easily and is now an accepted part of care.
After six months the results have been encouraging. Half of all handover forms are now completed by a professional other than a GP while calls to the hospice advice line have tripled.
Out of hours visiting doctors also appreciate the special training programme.
It is now planned to develop an out of hours good practice guide, covering several successful models.
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