What is the challenge your project is going to address and how does it connect to the theme?

–   There is considerable evidence highlighting that referral to palliative care services is often late in disease course (most recently NACEL 2018/9)

• -Referral to palliative care services varies considerably between patients in different disease groups and those with non-malignant disease often do not access palliative care services despite significant symptom burden.
• Around 80% of elderly patients have at least one hospital admission in the last year of life, but many are not offered the opportunity to undertake advance care planning or (where appropriate) referred to specialist palliative care services.
• There have been recent projects using electronic tools within community electronic patient records which increase identification of those likely to have palliative care needs and benefit from further assessment, with positive evaluation.
• Very limited work has applied this approach to hospital electronic records but that which has been undertaken has shown promising outcomes with benefits being acknowledged by both health professionals and patients.

What does your project aim to achieve?

To improve early identification of hospital inpatients with palliative care needs through the use of a digital tool by May 2023.

This tool will help clinicians to identify patients in real time who are most at risk of death in the year following admission to hospital.  The tool will prompt clinicians to consider either referral to specialist palliative care services or other key non-specialist interventions, such as advance care planning, making advance decisions and ceiling of treatment decisions.

It is anticipated that the project will increase access to palliative care, particularly amongst groups who tend to access palliative care less frequently (patients with non-malignant disease as well as some minority ethnic and socioeconomically deprived groups). This early identification and intervention intends to help patients live well right up to the end of their lives and empowers them to make decisions which they may otherwise not have the opportunity to.

How will the project be delivered?

This innovative multi-centre project offers a unique opportunity to test a new tool and impact patients across 3 large acute hospitals (with potential additional other sites in the next 2 years).  A steering group including palliative care clinicians and dedicated project support  staff will direct, review and manage the programme.

• A steering group will support integration of the mHOMR tool into EPR with engagement from business information and EPR teams and roll out to all relevant clinical areas utilising Quality Improvement methodology
• A bespoke package of education, support and resources will be produced to empower clinicians
• Dedicated clinical nurse specialist and administrative support will enable the project to maintain momentum and engagement whilst mitigating the risk of inappropriate referral or palliative care interventions
• Teams members will develop their QI skills alongside this project with support from Aqua and in-house QI functions

How is your project going to share learning?

As well as support and learning from Q members, the project has engagement from the Greater Manchester and East Cheshire strategic clinical network for palliative care which provides an excellent forum to share learning of the real impact from this project.

Although this will focus on one EPR system initially, the principles and learning would be relevant to any hospital EPR system and would have nationally important findings.  The aim would also be to share learning through the wider palliative care and QI community and publish a review of findings in peer reviewed journals, presentations at conferences and other learning events.