A summary of the End of Life Care project, which was delivered by Hospice UK’s Quality Improvement team in partnership with NHS Improvement and four acute trusts across England.
The aim of the programme was to improve the quality of care for patients who may be in their last three months of life, who attend or are admitted to hospital in an emergency.
Why this work was needed
This work was necessary because we know that:
- People are more likely to be admitted to hospital in an emergency as they get closer towards their last days of life. In 2015, 67% of the total deaths in England (334,073 people) had at least one emergency admission in the last 90 days of life .
- Preferences for care may change and many admissions are unavoidable. They may be unwanted by the patient and their carer.
- Hospital costs make up the biggest proportion of costs at the end of life .
- Complexity is increasing, and comorbidity is increasing with increased life expectancy. We need new models of care to support the management of clinical uncertainty.
"Doctors and the public should be reminded of the inherent uncertainty in the pace of disease progression and that reversible and irreversible conditions can coexist and need to be assessed in the context of the patient’s wishes" 
Using a quality improvement approach, the programme had three distinct phases: understanding the current situation; defining the aim for the project; and an action phase.
Working with the four clinical teams and our clinical advisory group/faculty we developed a number of case studies.
Fresh eyes approach - A walk-through to improve people’s experience of care in the last months of life in acute hospitals
This report summarises our learning from our ‘fresh eyes’ walkthroughs of 12 acute hospital trusts, a key component of the programme’s approach to consider the patient, family and/or carers’ experiences by walking through a potential journey.
Fresh eyes report - Caring to the end: shining a spotlight on bereavement and mortuary services
This report summarises Hospice UK’s learning from our ‘fresh eyes’ walkthroughs of bereavement centres and mortuary services in 12 acute hospital trusts across England, taking part in two end of life care hospital improvement programmes supplemented with an analysis of mortality data.
This Rapid Improvement Guide is for acute clinical teams and has a focus on the lens of acute admissions for patients who may be in their last months of life.
The 'fresh eyes' approach to improve experience of care
The Emergency Care Improvement Programme’s (ECIP) End of Life Care Project aimed to improve care for patients who may be in their last months of life with a particular focus on the lens of acute hospital admissions.
A key component of our approach included a “fresh eyes” perspective on the experiences of care with a “walk through” of a potential patient / relative’s journey.
Based on the success of this independently evaluated programme the Hospice UK team were commissioned for a second phase by NHS Improvement. We worked with 8 sites over a 12 month period:
- Royal Cornwall Hospitals NHS Trust
- St Mary’s Isle of Wight NHS Trust
- Lewisham and Greenwich NHS Trust
- North Middlesex University Hospital NHS Trust
- George Elliott Hospital NHS Trust
- Ipswich Hospital NHS Trust
- University Hospitals of Leicester NHS Trust
- Shrewsbury and Telford Hospital NHS Trust
Executive Clinical Leads in Hospice and Palliative Care
- National End of Life Care Intelligence Network. End of life care Sustainability and Transformation (STP) Tool - Version 3. [Internet] 2017
- Georghiou T & Bardsley M. Exploring the cost of care at the end of life. London: Nuffield Trust; 2014
- British Medical Association. End-of-life care and physician-assisted dying. Vol. 3. Reflections and recommendations. London: BMA; 2016. See p. 24.