Nurse-led palliative care for patients without complex medical needs

During 2015-16, St Gemma’s Hospice in Leeds piloted an innovative service for patients approaching the end of their life who wouldn’t normally be eligible for hospice care as they don’t have complex medical needs. By making greater use of the skills of its experienced senior nurses and more efficient use of under-occupied beds, the project successfully widened access to hospice services.

In a project funded by our Innovating for Improvement programme, four existing beds in the hospice were given over to the project, with overall responsibility for the care of patients in these beds taken by a senior nurse. Patients with more complex needs continued to be admitted under the care of a medical consultant (as is normal for hospice in-patient units).

Before the project, those who had suffered an acute illness, such as a stroke, would not have met the hospice’s criteria. Others with long-term illnesses, but less complex needs, may have been deemed a lower priority. Nurse consultant Catherine Malia explains.

‘Sometimes patients who were referred to us for fairly straightforward end of life care were dying on our waiting list. Other patients would ‘trump’ them priority-wise and it felt wrong to have to deny hospice care to those who would like it. Reorganising our service and having separate eligibility criteria enables patients whose needs are more straightforward to access end of life care in a hospice if they wish.’

A collaborative approach to working with hospital colleagues, including new referrers, has been key to the success of the redesigned service. Previously, hospital patients were referred only via the specialist palliative care team. However, the team are now accepting direct referrals from wards such as cardiology and elderly care. Working together, all partners have streamlined referral processes. Nurses can also take same-day referrals over the phone where rapid response is needed.

A managed clinical network (MCN) of palliative and end of life care providers in Leeds, hosted by St Gemma’s, has enabled the hospice to build effective working relationships with the acute, community and ambulance trusts. This makes it easier to address any challenges around transfer of care. Referrals are also facilitated by the Leeds Care Record (which allows all health and social care services in Leeds to share patient records), as well as a dedicated palliative care ambulance resource in Leeds.

Catherine adds, ‘Strong leadership and great team work are critical. Our MCN has really helped to facilitate collaboration between health and social care providers. Their support, as well as that of the hospice leadership team and trustees was essential. Any innovation is a bit risky but they supported it and the payoff is that we now offer more people choice about where they access the high quality care they need during the crucial last days of their lives.’

As of October 2017, the team had helped 150 patients die in the place of their choosing, improving the quality of end-of-life care, reducing in-hospital deaths, and maximising the use of hospice beds while also developing nursing skills and knowledge. Following the pilot’s success, the team are now expanding the service and will increase the number of nurse-led beds from four to six by the end of 2017.

Earlier this year St Gemma’s became the first formally recognised University Teaching Hospice in the UK. The team educate other health care professionals in end of life care, including recognition of death and dying, communication skills and symptom management.

Read more about the project.