148 Impact at the front door? Exploring how prioritisation of specialist palliative care resource to the emergency department affects patient journey

<h3>Background</h3> Most patients attend the emergency department (ED) towards the end of life. There are various models of specialist palliative care (SPC) support for ED, however resources to implement are limited. We explore the impact of a service model developed from within an existing hospital SPC establishment on timing of review and length of stay (LOS). <h3>Methods</h3> The SPC-ED model was implemented in November 2023. An SPC team member is allocated to ED daily, responding to referrals face-to-face and liaising with ED staff to identify additional patients who may benefit from SPC support. Routine data on referrals, hospital LOS and outcome were analysed November 2023-April 2024 with November 2022-April 2023 as comparator. <h3>Results</h3> There were 1188 SPC referrals in the study period vs 1039 in the comparison period. Initial reviews were in ED were 396 (33%) vs 132 (13%). Median LOS for those who survived to discharge was lower in the study period (11 vs 15.5 days) and more patients were discharged directly from ED (39 vs 10). In the study period, 209 (53%) of those reviewed in ED survived to discharge and median LOS amongst these was 8 days. Of 792 patients first reviewed later in their hospital journey, 349 (44%) survived to discharge. Clinical records for these were reviewed. In 134, both the life-limiting diagnosis and SPC need prompting eventual referral were present in ED, suggesting earlier review may have been indicated. Median LOS for this group was 16 days. <h3>Conclusions</h3> This limited data suggests prioritisation of SPC resource to the ED led to review of patients earlier in their hospital journey and may have positively impacted LOS. Sustaining this within an existing hospital SPC establishment is challenging. Work is needed to establish the optimal SPC-ED service model and argue the benefits of fully resourcing this.