Yvonne Cartwright explains how a Sue Ryder Care rapid response service supported people in northBedfordshire to die at home
Around 500,000 people die in England each year, 55,000 of those in the east of England. On average people in the East of England are admitted to hospital three times and spend nearly a month of the last year of their life in hospital. Over half die in hospital. And, while 50 per cent of people express a wish to die at home, only 20 per cent of them do so. Obstacles to people’s preferences being met include complex and evolving symptoms and lack of timely access to those with additional expertise to improve them.
In response to these statistics and in line with recommendations in the Departments of Health’s End of Life Care Strategy to enable people to choose to die at home, Sue Ryder Care piloted a rapid response hospice at home service in North Bedfordshire (from September 2009 to end of February 2010).
Aims of the service:
- The main aim of the pilot service was to provide additional, rapidly available palliative care expertise to patients and those caring for them in their last days at home.
- The service aimed to facilitate a rapid discharge from hospital and the hospice while also preventing unnecessary transfers to hospital. If this could be replicated on a regional and national level this would release funds which could be allocated to meet other priorities in end-of-life care.
- The service complemented and extended existing community-based services by working in partnership with healthcare professionals caring for patients and their families in the community.
About the service:
The service was operated from Sue Ryder Care St John’s Hospice by a team comprising senior doctors, nursesand healthcare assistants with access to Consultant Medical advice. Everyday from 9am-5pm a nurse co-ordinator was available to liaise with community nurses to determine if and how the service could contribute to the patients’ care. On referral, care requirements were assessed and the appropriate care arranged in order to maintain the patients’ comfort and dignity at home and support the family and other carers. Support was in place for 72 hours in which time symptoms were continually assessed and managed and care provided as required.
Doctors from the hospice were available from 9am–5pm from Monday to Friday to visit patients, (after obtaining permission from the GP) and to provide advice regarding symptom control. Medical staff provided out-of-hours telephone advice for professionals involved with the patients, in addition to medical advice being available to any professional via the hospice.
Alongside additional nursing care, Sue Ryder Care’s rapid response team offered the families emotional support which continued after the patients’ death with bereavement support made available to all families involved with the pilot.
The Sue Ryder Care-funded six month pilot ended on 28 February this year, and initial evaluation results are very positive. The project supported 17 patients in their own homes, of which six were able to be discharged early from hospital because of the extra support they would be receiving at home.
Feedback from patients was enthusiastic: “Thank you very much for all the excellent care given to my husband,” one lady told our hospice team. “You helped me grant him his wish to die at home with me.”
Team members commented on the project’s acceptability to certain families for whom in-patient care would not have been acceptable for cultural reasons, and the ability to avoid a change in the place of care for a patient with cognitive impairment who would have found a move traumatic, thus widening the access to the care we provide.
The full evaluation, including details of the financial benefit, will be shared with the Bedfordshire PCT upon completion in the hope that they will continue to fund it.
The project evolved throughout its duration and flexibility was a huge advantage. Some patients required mostly medical intervention and advice for complex symptoms whilst for others nursing care and family support were the main interventions. Initially the idea was to offer intervention for up to 72 hours, in practice it was never withdrawn, so Sue Ryder Care staff visited for seven or eight days when this was required.
Yvonne Cartwright is a specialty registrar in palliative medicine based at Sue Ryder Care – St John’s Hospice www.suerydercare.org