Edinburgh Napier University

  Recent research[1] identified that 29% of patients in hospitals are at risk of deterioration &dying. The need to improve anticipatory care planning (ACP) for such patients requiresinnovative & system wide approaches.

Aim: To ensure patients in pilot areas receive care aligned to their needs & wishes throughintegration across hospital & community.

Methods: The Institute of Healthcare Improvement Model for Improvement[2] is used toexplore the current system, challenge assumptions & test changes regarding: Identification of patients at risk & reliable response Communication with patients & families regarding realistic goals, benefits/burdens ofinterventions, their wishes & concerns Integration of core elements of ACP within routine clinical processes Clear documentation of a multi-professional Goals of Care plan & sharing of information acrosscare settings: information reconciliation This iterative, participative approach has ensured clinician ownership. Measures used toevidence the reliability of processes & impact on patient outcomes will be reported. Datacapture includes audit of clinical documentation, observations of Professional clinicalpractice and semi-structured interviews with patients, carers and staff.

Findings: Findings from pilot areas challenge current literature by indicating that ACP isappropriate for over 75% of patients in pilot areas. This presentation will include the impactof interventions on care processes & outcomes including acceptability of ACP approaches.

Additional output: Exploration of a core skill set for staff regarding best practice Glossary of terminology has been defined to enable a consistent approach. Collaboration to expedite progress. Testing of quality improvement approaches in palliative care.

1. Clark et al(2014) Imminence of Death Among Hospital In-Patients. Pall Med 28(6)474–9
2. www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementHowtoImprove.aspx