16 Palliative care in a crisis: findings from an innovative acute palliative care ward with emergency department (ED) in reach

<h3>Introduction</h3> Marie Curie REACT (responsive emergency assessment and community team) provides acute palliative care to patients in crisis via a virtual palliative care ward with ED in-reach. It aims to provide short term (&lt;3 day) symptom management, Advance Care Planning, interventions (SC medications including antibiotics and fluids) and carer support to provide an alternative to hospital or hospice admission. <h3>Method</h3> We present data collected on hospital unplanned bed days, hospital admissions and ED attendances in the last year of life for those patients known to REACT in the first 2 years of service. <h3>Results</h3> 893 patients have been referred to the service and 592 have died: these are the patients we are able to calculate data from their last year of life. On average this cohort has 18 unplanned hospital bed days in the last year of life, 20 if they are admitted after ED review and 15 if they are discharged to the virtual ward; on average they have 2 unplanned admissions and 3 ED attendances. <h3>Conclusions</h3> National data suggests that hospital usage in the last year of life is around 30 days with 3–5 admissions. Our own local data is 38 days which reflects the impact of ethnicity and deprivation on hospital usage at the end of life. Our data halves the local hospital unplanned bed day usage in the last year of life with a corresponding reduction in admissions. Through excellent palliative care and with sufficient resource it is possible to impact on acute hospital usage and provide better, more personalised care for palliative care patients in a crisis.