83 Improving end of life care in the surgical department by improving surgeons’ confidence

<h3>Problem</h3> 40–50% of deaths in England occur in hospital, and therefore clinicians must be able to care for patients who are approaching or at the end of life[3]. NICE guidelines state that most of this care is given by professionals who are not palliative care specialists, but that specialist advice should be sought when necessary[1]. While working in the surgical department as an FY1 doctor, I experienced multiple cases of patients who were not suitable for surgical intervention and therefore were ‘for End of Life Care’. There was a high reliance on the Specialist Palliative Team to manage these patients. This Quality Improvement Project aims to improve the quality of End of Life (EOL) Care in the surgical department in AA Hospital. <h3>Methods</h3> The most appropriate and time-sensitive process of measuring improvement was to assess surgeons’ confidence in managing EOL patients. With the assistance of the Specialist Palliative Care Team, an intervention was created to provide a holistic and structured approach to managing EOL patients. This was designed to be similar to the Falls Assessment tool – already in use in the surgical department, and therefore, a familiar format. The surgeons were surveyed before the implementation of this intervention. A teaching session was then delivered to provide an opportunity for familiarisation and questions. After an eight week implementation period, the surgeons were re-surveyed, to assess if confidence had improved. <h3>Results</h3> Confidence improved in all measures; including recognising EOL, formulating holistic care plans, and discussing EOL with patients and families. Over 70% of participants agreed that End of Life Care had improved as a result of the intervention. Qualitative data trends suggested a need for continued teaching, especially on holding difficult conversations. Ideally, this intervention should be introduced at all staff inductions, and regular communication skills training should be arranged.