P-190 Transforming palliative day services to improve access and quality for patients, carers and staff

Abstract

Background Pressures on hospice resources are ever increasing and innovative approaches to service provision are needed to meet demand in a timely manner while maintaining a quality service (National Palliative and End of Life Care Partnership, 2015; National Institute for Health and Care Excellence, 2017). Following service feedback and literature review we reconfigured day services to run a closed self-management group for patients with fatigue, anxiety and breathlessness, to create capacity and enhance patient experience (Galdas, Fell, Bower et al., 2015; Bradley, Frizelle & Johnson, 2011; Low, Perry & Wilkinson, 2005). We are evaluating the effect of this on patient satisfaction and service delivery. Aims Evaluate effectiveness of service transformation from individual breathlessness management clinics to the delivery of closed, interdisciplinary, mixed diagnosis, self-management groups for patients and carers. Methods October to December 2016: Literature review, feedback analysis, service review, model design, internal consultation, marketing and recruitment, patient information pack created. January 2017: Pilot group. February 2017: Commenced delivery of FAB group. IPOS was used as an outcome measure alongside a non-standardised patient feedback form. Early 2018: Results were analysed after one year of repeated programmes. Results Increase in patient contact hours from 80 to 441 hours annually, 220.5 hours per staff member, a 176% increase. Broadened service provision to address more diverse conditions, with a 125% increase in contact time per patient. Interdisciplinary working enabled staff up-skilling and multi-professional support for patients. Qualitative feedback (non-standardised form): 100% positive from patients, carers and partner organisations/referrers. Quantitative feedback (IPOS): limited and biased due to attrition and response shift. ‘Views on care’ was added following one year analysis, as a further evaluation tool. Conclusions Interdisciplinary groupwork offers many benefits to service users and palliative care providers in terms of expanding service provision and enhancing patient experience within limited resources. Quantitative outcome measurement in educative palliative care programmes is problematic and evaluation of tools from the OACC suite is ongoing.