44 Moving forward: hospices managing crisis

<h3>Background</h3> Hospices have changed considerably over recent years in terms of the increased complexity of people they care for and the novel services they deliver to improve the quality of end-of-life, support preferred place of care and alleviate compound pressures on acute hospital services. Nationally hospices are innovating, particularly in finding ways to manage palliative care crisis which people often experience in the final three months of life; many resulting in Emergency Hospital Admission. <h3>Methods</h3> (1) Secondary analysis of qualitative interviews with staff, stakeholders and public representatives to identify how hospices are managing crisis in the Midlands region of England and the resource support they get from their ICB. (2) Quality improvement evaluation of one hospice-based innovation aimed to prevent emergency hospital admission and enable early hospital discharge for people at the end-of-life through audit of admissions, narrative case note analysis and carer and staff feedback. <h3>Findings</h3> Crisis interventions can be categorised into: (1) Telephone support (providing advice); (2) Rapid response (providing urgent homecare); (3) Digital innovations Virtual wards (providing digital remote care); and (4) Hospice-based/care home admission avoidance (providing inpatient care). However, no research has shown the impact each have on enabling preferred place of care, the quality-of-care experience, who is accessing them or costs. Further quality improvement analysis of one hospice-based admission innovation showed a positive impact on quality-of-life from carer feedback and reduced costs in comparison to hospital admission. Findings highlighted challenges with communication within the wider system and resource allocation to sustain the innovation long-term. <h3>Conclusion</h3> Innovations are vastly lacking in research to evidence their impact and sustainability but are likely beneficial at enabling preferred place of care, improving quality of end-of-life and alleviating pressures on the wider health and social care system.