While no one wants to talk about death the reality is we all die at some point and that we now know from studies now that on average 30% of patients admitted acutely to hospital on any given day will die within a year. I know from my day to day work in a hospital palliative care team this means about 1500 patients die in our hospital every year but many more will have most of their interaction with the hospital & have a range of interventions within this last year period. However most patients have previously expressed wishes to minimise unnecessary medical intervention during this last year.

We are as professionals very bad at is identifying and communicating this to people along with the uncertainty of what to do for the best. We also have data that suggests on average 50% would wish to die at home while less than 20% do. We wanted to identify these groups of patients to enable discussions around care and avoiding unnecessary admissions where possible. We adapted elements from the NHS Improving Quality end of life care transforming hospitals and obtained funding from the local PCT (as it was) to expand our team so we could rapidly get people out of hospital at the end of their lives and link them into a local hospice & palliative care services, district nurses , care and their GP.

All this could not be achieved without lots of conversations with the patients their relatives and friends and the professionals involved both in the hospital and the community. We are really proud of the work we do , the service has grown exponentially over the last 3 years and seeing all the headlines of “delayed discharges” & “bed blockers” our team works tirelessly to educate and help people get out and stay out of hospital. We are more than happy to share our learning and the trials and tribulations of setting up & now running an ever expanding service – do get in touch if you want to know more.

About the Author:

I'm a Macmillan consultant and honorary senior lecturer in palliaitve medicine at St George's University Hospitals NHS foundation trust I'm interested in research in symptom biology in cancer both during and after treatment & actively engaged in promoting the best care at the end of life with a 7 day hospital palliative care team


  1. Cazzatty 14 February 2015 at 8:09 pm

    Hi, I am helping devise a flowchart for hospital discharges for good end of life discharges, and wondered if you had any problem areas that cause added concerns

  2. ominton
    ominton 15 February 2015 at 7:15 am

    The main thing is to get all stakeholders involved – pharmacy – injectable and CDs , transport to prioritise the slots and then have a system to alert GP , DN and care agency
    We as a team take the lead so ensuring someone coordinates it all

  3. ominton
    ominton 20 April 2016 at 2:09 pm

    Update as of April 2016 we have appointed a band 7 CNS within our team to specifically co-ordinate our fast track discharge from hospital process.
    We think this is the 1st in the country and are very proud we have been able to do this and more than happy to share the process to anyone interested

  4. ominton
    ominton 17 June 2016 at 4:31 pm

    The number of referrals agreed by the palliative care team to be eligible for ‘Fast Track’ under the revised National framework during the period of April 2015 – March 2016 was 285. This is an increase of 17.28% from 2014 – 2015. We’ve gone from 80 to nearly 300 innovation at its best

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