Case study:

04 February 2009

Integrated care pathway for the rapid discharge home of a dying patient in NHS Great Yarmouth and Waveney

Key points

NHS Great Yarmouth and Waveney plans to introduce an integrated care pathway for rapid discharge home of all dying patients who request it, following a six-month pilot.

The pathway, which incorporates elements of the Liverpool Care Pathway but is specifically developed to the local area’s needs, also includes special palliative care packs. These contain small items of equipment that are usually needed for end of life care such as disposable slide sheets, urinals and mouth care packs.

The pathway has within it documentation to be used by staff from the acute unit, ambulance crew, community nursing teams and GPs.

The new approach aims to improve patients’ experience, promote their choice and provide relatives and carers with the necessary support, information, training, equipment and services.

The pilot stage is currently being audited and once this is complete and any proposed changes made, the trust will embark on a widespread education programme for all staff involved in rapid discharge. Use of the palliative care packs is also being audited.

The rapid discharge initiative began as a joint working project between the discharge team at the acute hospital, the local community nursing teams and the specialist palliative care team. Between them they developed the pathway and a proposal for funding the palliative care packs.

The development of the pathway has encouraged joint working and strengthened cross boundary relationships. It has also given the team a clearer understanding of each other’s roles and the challenges experienced by professionals in different settings.

However, the pilot also threw up some problems. On several occasions the full pathway was not photocopied before the patient was discharged so there was no copy within the patient’s medical records which meant the documentation was difficult to locate.

It was also agreed initially that the palliative care packs would only be used for patients who are discharged rapidly to die at home. But this rule has proved difficult. If, for example, equipment needed by a palliative care patient cannot be supplied through the usual channels, the specialist palliative care team may supply this item from the rapid discharge stock. It is intended to monitor this need and build it into the proposal for further funding.

Once this is complete the team will work to ensure the pathway is embedded into clinical practice by continuing to monitor and audit the use of the pathway on an annual basis.