Building on the Best: Improving end-of-life care in acute hospitals Dr Barbara Kimbell Project Manager Scottish Partnership for Palliative Care

Background Macmillan Cancer Support identified improvements in palliative and end-of-life care in acute hospitals as a priority 2-year UK-wide quality improvement programme Launched April 2016 in England (10 sites), October 2016 in Scotland (3 sites) All conditions Four areas of improvement focus: Shared decision-making Effective information transfer Care planning in outpatients Pain and symptom management

Project focus in Scotland (BobScot) Shared decision-making (SDM) in relation to people with advanced illness and/or frailty, with a particular focus on transition points, i.e. at entry to and exit from the ward. Not specifically focused on the end of life, but all aspects of decision-making in the context of deteriorating health and uncertain outcomes, e.g. goals of care, treatment escalation, location of care, DNACPR

Building on good practice

Existing foundations

Project sites in Scotland Acute Medicine & Gastroenterology

Project approach Scope current practice on participating wards using rapid appraisal: observation documents and data individual/group interviews with staff, patients, carers In partnership with patient and carer groups, develop new resources and approaches to prepare patients and carers better for shared decision-making in hospital when people are deteriorating. Develop initial quality improvement plan: Select priorities, collate baseline data Act Plan Do Study

Progress so far...  Ninewells Hospital: Scoping of current practice in participating wards completed and feedback provided  Royal Infirmary of Edinburgh: Scoping underway  6 PPI focus groups and virtual PPI network feedback on draft resource Emerging findings... Locally, room for improvement regarding team communication, staff training, effective documentation and transfer of information. Patients generally satisfied with level of involvement in SDM, carers less so.

Agreed areas for QI testing All sites... Communication aids for staff Awareness-raising leaflet/poster for patients and families ...plus Local ward-specific priorities (e.g. as identified through scoping) as appropriate