Being at home at the end of life

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.