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Bundle of care to drive improvements in palliative and end-of-life care (PEOLC) in an acute tertiary hospital

OBJECTIVES: There is little evidence to suggest the best model of palliative and end-of-life care (PEOLC) in an acute care hospital. We introduced a bundle of care to drive improvements in PEOLC; this bundle included three full-time nursing positions providing a palliative care clinical consult serv...

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Autores principales: Bell, Liam, Sebastian, Amanda, Palazzi, Kerrin, Farquhar, Saxon, Attia, John, Lacey, Jeanette
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10565339/
https://www.ncbi.nlm.nih.gov/pubmed/37802540
http://dx.doi.org/10.1136/bmjoq-2023-002358
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author Bell, Liam
Sebastian, Amanda
Palazzi, Kerrin
Farquhar, Saxon
Attia, John
Lacey, Jeanette
author_facet Bell, Liam
Sebastian, Amanda
Palazzi, Kerrin
Farquhar, Saxon
Attia, John
Lacey, Jeanette
author_sort Bell, Liam
collection PubMed
description OBJECTIVES: There is little evidence to suggest the best model of palliative and end-of-life care (PEOLC) in an acute care hospital. We introduced a bundle of care to drive improvements in PEOLC; this bundle included three full-time nursing positions providing a palliative care clinical consult service with physician backup, as well as educating staff, using the NSW Resuscitation Plan and the Last-Days-of-Life Toolkit. METHODS: Two audits were performed at John Hunter Hospital, a tertiary hospital in Newcastle, Australia, each sampling from all deaths in a 12-month period, one prior to and one after the bundle of care was introduced. Sampling was stratified into deaths that occurred within 4–48 hours of admission and after 48 hours. Key outcomes/data points were recorded and compared across the two time periods. RESULTS: Statistically significant improvements noted included: lower mortality on the wards after 48 hours of admission, better recognition of the dying patient, increased referral to palliative care nurses and physicians, reduction in the number of medical emergency team calls and increase in the use of comfort care and resuscitation plans. Currently, 73% of patients have their end-of-life wishes observed as per their advance care directive. CONCLUSION: A bundle of care involving dedicated nurses with physician backup providing a consult service and education is an effective method for driving improvements in PEOLC.
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spelling pubmed-105653392023-10-12 Bundle of care to drive improvements in palliative and end-of-life care (PEOLC) in an acute tertiary hospital Bell, Liam Sebastian, Amanda Palazzi, Kerrin Farquhar, Saxon Attia, John Lacey, Jeanette BMJ Open Qual Original Research OBJECTIVES: There is little evidence to suggest the best model of palliative and end-of-life care (PEOLC) in an acute care hospital. We introduced a bundle of care to drive improvements in PEOLC; this bundle included three full-time nursing positions providing a palliative care clinical consult service with physician backup, as well as educating staff, using the NSW Resuscitation Plan and the Last-Days-of-Life Toolkit. METHODS: Two audits were performed at John Hunter Hospital, a tertiary hospital in Newcastle, Australia, each sampling from all deaths in a 12-month period, one prior to and one after the bundle of care was introduced. Sampling was stratified into deaths that occurred within 4–48 hours of admission and after 48 hours. Key outcomes/data points were recorded and compared across the two time periods. RESULTS: Statistically significant improvements noted included: lower mortality on the wards after 48 hours of admission, better recognition of the dying patient, increased referral to palliative care nurses and physicians, reduction in the number of medical emergency team calls and increase in the use of comfort care and resuscitation plans. Currently, 73% of patients have their end-of-life wishes observed as per their advance care directive. CONCLUSION: A bundle of care involving dedicated nurses with physician backup providing a consult service and education is an effective method for driving improvements in PEOLC. BMJ Publishing Group 2023-10-06 /pmc/articles/PMC10565339/ /pubmed/37802540 http://dx.doi.org/10.1136/bmjoq-2023-002358 Text en © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Original Research
Bell, Liam
Sebastian, Amanda
Palazzi, Kerrin
Farquhar, Saxon
Attia, John
Lacey, Jeanette
Bundle of care to drive improvements in palliative and end-of-life care (PEOLC) in an acute tertiary hospital
title Bundle of care to drive improvements in palliative and end-of-life care (PEOLC) in an acute tertiary hospital
title_full Bundle of care to drive improvements in palliative and end-of-life care (PEOLC) in an acute tertiary hospital
title_fullStr Bundle of care to drive improvements in palliative and end-of-life care (PEOLC) in an acute tertiary hospital
title_full_unstemmed Bundle of care to drive improvements in palliative and end-of-life care (PEOLC) in an acute tertiary hospital
title_short Bundle of care to drive improvements in palliative and end-of-life care (PEOLC) in an acute tertiary hospital
title_sort bundle of care to drive improvements in palliative and end-of-life care (peolc) in an acute tertiary hospital
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10565339/
https://www.ncbi.nlm.nih.gov/pubmed/37802540
http://dx.doi.org/10.1136/bmjoq-2023-002358
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