Case study:

04 February 2009

Rapid discharge pathway from hospital to home of the dying patient in Salford Royal Foundation Trust

Key points

Salford Royal Foundation Trust has successfully piloted a rapid discharge pathway from hospital to home for dying patients who choose to spend their last days at home.

During an eight-month pilot period the team were able to facilitate the rapid discharge of eight out of an initial group of 12 patients and it is now planned to roll out the pathway to all wards across the trust.

The project involved setting up a working group of key stakeholders across acute, primary and allied organisations such as the North West Ambulance Service (NWAS) to help adapt the Liverpool Care Pathway for rapid discharge of dying patients. Greater Manchester Police were involved at a later stage.

The hospital palliative care team then developed a training pack and delivered education to those staff that needed it. It also provided ongoing support to ward staff during the pilot phase.

Following the training, completed Rapid Discharge Pathway documents were audited, reports prepared and an action plan completed. A sample of 12 patient pathways were audited, consisting of five men and seven women (seven from medical directorate, two from surgical directorate, one neurological services, one emergency medicine and one critical care).

Although the pilot was successful it did raise an issue around defining the responsibilities for verification and certification of expected death in the home and determining the appropriate involvement of the coroner. This has led to discussions with the both primary and secondary care trusts and the coronial services with the aim of developing a policy for the Greater Manchester and Cheshire Cancer Network region.

The planned roll-out of the Rapid Discharge Pathway will be accompanied by a structured education programme for nursing staff across the trust and training for undergraduate and postgraduate medical staff. The rapid discharge document will be re-audited bi-annually.