Discontinued due to COVID-19
What are the functional characteristics of well-connected end-of-life care that facilitate rapid and effective transfers from hospital to a dying person’s preferred place in the community?
Despite the compelling quality, legal and financial imperative to facilitate discharge to a preferred place of death, many people are dying in hospital against their wishes. A ‘window of opportunity’ for discharge can be missed due to changes in medical condition, poor communication between partner agencies, and difficulty securing the appropriate level of community support. Data from a hospital in England in 2016 showed that over a third of the deaths (37.5%) occurred while the dying person was waiting to be discharged. These data indicate the importance of the functionality of the ‘rapid supported discharge’ process, which, when operating as intended, should enable a person to die in their preferred place of care
Planning a rapid discharge from hospital for someone near to death involves people and organisations working together and communicating effectively with the dying person and their family to ensure a safe and efficient transfer of care that promotes dignity and compassion. Recent evidence indicated that over a third of hospital deaths reviewed happened while the dying person was waiting to be transferred. A common reason for delays is that a package of care can’t be coordinated in time because of limited availability of community support.
In this project we will study how care services, volunteers, and the dying person’s family interact together to coordinate transfers to the dying person’s preferred place of care. We will research ways to better connect them to support good continuation and consistency in caring relationships at end of life.
i) To better understand current interactions between support networks in end of life care from a variety of perspectives (including: statutory support services, informal networks of care, volunteers, and the third sector)
ii) To identify any difficulties in these interactions that may prevent a dying person's rapid transfer of care from hospital to a community setting
iii) To explore possible ways to improve current interactions
i) To work with a variety of stakeholders in two deliberative workshops to explore previous experiences of how different support networks interact in end of life care
ii) To collate the findings from these workshops in order to identify any recurring themes or issues as identified by stakeholders
iii) To run a third workshop based on the collated findings in order to collaboratively explore how end of life care might be improved
iv) To co-develop a logic model and agree the determinants of a successful outcome for a larger research study.
14 preparatory interviews were completed with health care professionals.
All workshops were oversubscribed in March/April 2020 and an additional workshop was planned to accommodate those interested in participating.
All workshops had to be cancelled due to the onset of Covid-19.
Potential or actual impact
The project was placed in abeyance.
Papers/resources associated with this study
A paper describing the findings from the preparatory interviews is under review for publication.
Additional funding support is being sought to broaden the reach of this project across multiple acute settings in Norfolk and Waveney
This project relates to the Compassionate Communities work being conducted in the Great Yarmouth and Waveney area co-funded by Norfolk CCG. St Elizabeth hospice is the main clinical partner.
Who is involved?
Researchers and institutions
Guy Peryer & Jessica Blake
University of East Anglia
Palliative and end of life care