99 Right here, right now: evaluation of a hospice virtual ward providing urgent care in the community

<h3>Background</h3> The NHS long term plan aims to shift hospital care to the community and deliver personalised care when it is needed. 95% of patients in the last year of life access unscheduled-care yet many express a preference for care out-of-hospital. Patient feedback was received to an integrated specialist palliative care service (SPCS) that community services did not always respond as quickly as needed. <h3>Method</h3> A 14 month, 10-bed, hospice virtual ward (VW) pilot was undertaken (ICB/hospice charitable funding) to evaluate the impact of an urgent-response SPCS (population: 235000). A daily clinical huddle and increased workforce capacity (palliative medicine, clinical nurse specialist, hospice-at-home care shifts) enabled same-day assessment and intervention for community patients in crisis and supported early discharge from hospital. The service closed as no recurrent statutory funding was identified. <h3>Results</h3> There were 900 admissions to the VW (545 patients). There were 17 hospital admissions (2%), 56 hospice admissions (6%) and 43 care home admissions (5%). 169(19%) died whilst supported by the VW. Average length of stay was 4.8 (z51.5 coded hospital admission: 13; hospice in-patient:8.7). Patient, carer and staff satisfaction was excellent. Since the end of the pilot, new patients to service receiving initial triage within 48 hours has dropped from &gt;90% to 68% and primary care services have raised concerns at the impact of the closure. <h3>Conclusion</h3> Patients approaching the end of their lives have fluctuating health and high symptom burden requiring timely specialist assessment. Consultant oversight, and liaison with primary, secondary and tertiary care, facilitates management of complex clinical situations and ensures senior decision making where needed. Hospice VWs provide an effective alternative to urgent-care services, with care delivered by the right professional, in the right place, at the right time. Individualised care, in line with patient preferences, is shifted from hospital to community.