Care First-Fund Later (CareFFuL): an end-of-life home care quality improvement project.
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Authors
Morrison, Jo
Robinson, Fiona
Witney, Ally
Greene, Helen
Marks, Clare
Davis, Charles
Issue Date
2024-05-30
Type
Journal Article
Language
en
Keywords
Wessex Classification Subject Headings::Eldery care.::Palliative care
Alternative Title
Abstract
Previous work found referrals for end-of-life care are made late in the dying process and assessment processes for care funding, through continuing healthcare fast-track funding often inhibit people being able to die at home. The average time to discharge was 6.3 days and 29% died in hospital, as median survival was only 15 days.We aimed to support discharge to home within 1 day by December 2023 for patients, wishing to die at home, referred to the end-of-life discharge team in a medium-sized district general hospital in Southwest England.In phase 1, we identified 13 people on a patient-by-patient basis, learning from obstacles. Barriers identified included sourcing of equipment, communication between teams and clunky paperwork. Median time to discharge was 2 days (range within 24 hours to 8 days) with 2/13 (15.4%) dying prior to discharge. In phase 2, we extended the pilot, and 104 patients were identified; 94 people were discharged to home, with a median of wait of 1 day (range 0-7) to discharge, and 10 (9.6%) died prior to discharge (median 1 day; range 0-4). Median survival from discharge for the 94 who achieved their wishes to go home to die was 9 days (range 1-205 days). Only 26/94 (27.7%) people survived more than 30 days.Rapid decision-making and structures to support home-based end-of-life care can support more people to die in their preferred place of care, by using a community-based rapid response team instead of, or in parallel with continuing healthcare fast-track funding referral applications. Current pathways and funding models are not fit for purpose in an urgent care scenario when we have only one chance to get it right.
Description
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Citation
Morrison, J.; Robinson, F.; Witney, A.; Greene, H.; Marks, C. and Davis, C. (2024) 'Care First-FUnd Later (CareFFuL): an end-of-life home care quality improvement project', BMJ Open Quality, 13(2) e002790. Available at: https://doi.org/10.1136/bmjoq-2024-002790
Publisher
BMJ
License
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Journal
BMJ open quality
Volume
13
Issue
2
PubMed ID
ISSN
2399-6641