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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2023
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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. |
format | Online Article Text |
id | pubmed-10565339 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
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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