1. Building on the Best: Improving end-of-life care in acute hospitals
Dr Barbara Kimbell
Project Manager
Scottish Partnership for Palliative Care

2. Background
Macmillan Cancer Support identified improvements in palliative and end-of-life care in acute hospitals as a priority
2-year UK-wide quality improvement programme
Launched April 2016 in England (10 sites),
October 2016 in Scotland (3 sites)
All conditions
Four areas of improvement focus:
Shared decision-making
Effective information transfer
Care planning in outpatients
Pain and symptom management

3. Project focus in Scotland (BobScot)
Shared decision-making (SDM) in relation to people with advanced illness and/or frailty, with a particular focus on transition points, i.e. at entry to and exit from the ward.
Not specifically focused on the end of life, but all aspects of decision-making in the context of deteriorating health and uncertain outcomes, e.g. goals of care, treatment escalation, location of care, DNACPR

4. Building on good practice

5. Existing foundations

6. Project sites in Scotland
Acute Medicine & Gastroenterology

7. Project approach
Scope current practice on participating wards using rapid appraisal:
observation
documents and data
individual/group interviews with
staff, patients, carers
In partnership with patient and carer groups, develop new resources and approaches to prepare patients and carers better for shared decision-making in hospital when people are deteriorating.
Develop initial
quality improvement plan:
Select priorities, collate baseline data
Act
Plan Do
Study

8. Progress so far...
 Ninewells Hospital: Scoping of current practice in participating wards
completed and feedback provided
 Royal Infirmary of Edinburgh: Scoping underway
 6 PPI focus groups and virtual PPI network feedback on draft resource
Emerging findings...
Locally, room for improvement regarding team communication, staff training, effective documentation and transfer of information.
Patients generally satisfied with level of involvement in SDM, carers less so.

9. Agreed areas for QI testing
All sites...
Communication aids for staff
Awareness-raising leaflet/poster for patients and families
...plus
Local ward-specific priorities (e.g. as identified through
scoping) as appropriate