P-96 Reaching those in need of end of life care: insights from a community palliative care in-reach service pilot at North Middlesex university hospital

Abstract

<h3>Introduction</h3> Many people in the UK do not have access to the right support at the end of life. This is reflected in Haringey, north London, where the community palliative team has only been able to reach 50% of patients estimated to be in their last year of life.¹ Around 1 in 4 patients aged over 75 in acute hospital beds are in the last year of life, yet few referrals to community palliative services come from this setting.² We hypothesized that providing a community palliative in-reach service to emergency and medical admissions units could help identify and reach more people in need of end of life care. <h3>Methods</h3> A community palliative care in-reach service was provided through once or twice weekly attendance of a designated in-reach doctor to the emergency department and 2 acute admissions wards over a 4-month period to seek direct and indirect referrals. Data collected included the number of patients identified as suitable and referred and outcomes of contact with the service. <h3>Results</h3> Over 25 attendances to 3 acute units, 29 patients were identified as suitable for palliative input. 8 of these could not be contacted. Reasons for this included that the patient was too clinically unwell or not available for assessment. Of 21 patients that were contacted; 7 declined input and 14 received input including holistic assessment, advanced care planning and creation of a CMC record. Of these 14, 7 required ongoing community support after discharge. <h3>Conclusions</h3> Our pilot demonstrates that a significant number of people in need of community palliative care support can be found in acute hospital units. The fact that only around half of patients identified as suitable received input reflects the challenges of providing holistic palliative assessment and advanced care planning in the acute inpatient or emergency environment. Further work is needed to explore ways of best reaching patients in need of palliative care support in the acute hospital setting. <h3>References</h3> Haringey Integrated Palliative Care Service (2021). Haringey Integrated Community Palliative Care Service Annual Report 2020–2021. Public Health England (2020). Older people’s hospital admissions in the last year of life.