145 Transformative emergency department (ED) care and new pathways in a tertiary hospital

<h3></h3> Despite exceptionally hard work done in the community it is sometimes not feasible or practical for patients to die at home. A Macmillan funded Specialist Palliative role was created to increase the early identification of patients in the dying phase and reduce the number of deaths within ED. To offer an alternative discharge option End of Life Care (EOLC) beds were created in a community hospital linked to the Acute Trust. The intention was to provide a peaceful and supportive environment for patients recognised as being in their last days or short weeks of life who were not appropriate for discharge home due to patient choice or care needs. A pathway was created to allow rapid transfer from ED into the supportive EOLC beds without requiring admission to the Acute Trust. The acute Hospital Specialist Palliative Care Team provided training and onsite support to up-skill staff in the community hospital. A ‘palliative ward round’ was done at regular intervals. As well as offering a better environment for dying patients the supportive EOLC beds also reduced pressure on acute hospital beds. Each patient transferred into the community hospital EOLC bed equated to an average saving of 10.5 acute hospital bed days. Patients transferred from ED had an average length of stay of 3.5 days, those transferred from the acute hospital trust stayed for an average of 14 days. There has been an increase from 1% to 10–14% of all hospital deaths occurring in community hospitals. There has also been a significant decrease in deaths in ED. The creation of designated EOLC beds in the community hospital and design of pathways from the acute trust has significantly improved the rates of patients dying in the ED or in the acute hospital setting, leading to improved patient experience.