56 Putting the ‘fast’ back into fast-track: a hospital palliative care team’s quality improvement project to improve fast-track discharges

<h3>Introduction</h3> Nearly half of deaths in the UK occur in hospital despite most palliative patients wanting to die outside of a hospital setting. Fast-track Continuing Care (FTCC) discharges need to occur promptly to ensure patients die in their preferred place of care. This quality improvement project, at Whipps Cross Hospital, sought to improve and streamline the FTCC process. <h3>Methods</h3> Retrospective data was collected for all medical patients in the hospital that were deemed eligible for FTCC at three separate intervals over one year. Change interventions to improve the FTCC process were put in place between each data collection, including the creation and implementation of a FTCC guidance tool and a flow chart detailing the process to follow and recommended timelines. The material was included in hospital-wide teaching sessions, distributed across ward offices, disseminated to department leads and managers, uploaded on the Trust intranet, and included in the doctors’ induction booklet. <h3>Results</h3> FTCC data was collected from 13 wards at our district general hospital. The median time from FTCC discussion to discharge improved by 4 days, from 10 to 6 days. The median time from admission to initial FTCC discussion improved by 10 days, from 24 to 14 days. The median time from initial FTCC discussion to paperwork submission improved by 2 days, from 4 to 2 days. The median time from paperwork ratification to discharge improved by 2 days, from 5 to 3 days. <h3>Conclusion</h3> The implementation of measures to improve each step of the FTCC discharge process have been effective, with improvements in every stage. The challenge to maintain this improvement remains, in view of doctors’ rotational posts, and the large number of wards to support. There remains a need for earlier identification of the deteriorating patient in order to commence the FTCC process earlier in a patient’s admission.