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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

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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 (National End of Life Care Intelligence Network, 2017) 
  • 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. (Nuffield Trust, September 2014)
  • 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"
(BMA (2016) Volume 3: Reflections and recommendations)

Working together

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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.

Learnings

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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