138 Impact of dedicated palliative care support to vascular surgery team in management of inpatients – service evaluation

<h3></h3> Inpatients with vascular disease have a high prevalence of symptom burden, multi-morbidity and significant short-term morbidity/mortality rates. These patients would often benefit from earlier specialist palliative care input, which is often under-utilised. In this pilot, palliative medicine consultant presence was introduced to vascular surgery MDT discussions of inpatients in a tertiary centre hospital. This retrospective case note audit reviewed the 12 month outcomes of those discussed. Outcomes were evaluated to assess whether patients at high risk of approaching the end of their life could be earlier identified and, therefore, referred to Specialist Palliative Care. Explicitly, this pilot did not offer proactive palliative care input, unless clearly required urgently or formally requested. 174 patients were discussed in the presence of a palliative care consultant. 12 months post-MDT discussion, 31/174 (17.8%) patients had died, and 9 had suffered re-admissions and high-morbidity, i.e. 40/174 (23%) of patients had high morbidity/mortality. Of these 40 patients, 13 (32.5%) were referred for palliative care input. Retrospective analysis demonstrated that palliative medicine consultant screening of MDT discussions identified 33/40 (82.5%) of those high morbidity/mortality patients as potentially benefiting from palliative care input. These needs can be described thematically: Imminently dying (2.9% of patients discussed) Prognostic uncertainty, i.e. potential for non-recovery from acute episode (9.7%) Possible last year of life, i.e. potential need for advance care planning (24.1%) Pain/symptom control needs (9.7%) Other (3.4%) 87 patients were not considered to have palliative care needs at time of discussion. 7/87 (8%) of these transpired to have been in high morbidity/mortality groups. This pilot demonstrates that senior Palliative Care presence at Vascular Surgery MDT meetings offers earlier identification of inpatients that may benefit from timely specialist palliative care input.