During the first COVID-19 lockdown, the clinical picture changed at Compton Care. The inpatient unit had to adapt to respond to the pandemic while the need for care at home increased. Support at home was required day and night.
The hospice identified the need for a Rapid Response service, to provide patients and carers with the support they needed, when they needed it. The service would enable the hospice to better manage crises and help prevent unnecessary hospital admissions.
To make their community teams more responsive, the hospice divided the existing Specialist Palliative Care Team in two (this consisted of Clinical Nurse Specialists and Healthcare Assistants). A new lead role was appointed, along with Advanced Nurse Practitioners, Clinical Nurse Specialists and Paramedic Practitioners.
The new teams assess what each person and family needs, provide urgent care, and support fixed caseloads. Virtual assessments were introduced so that people who have urgent and complex needs can be prioritised for face-to-face, at-home care. The hospice has also invested in non-medical prescribing.
Outcomes
The hospice developed a 24 hour, seven-day community model with a response time of four hours. As the service has developed, the response time has been reduced to two hours.
This model of care has enabled the team to build collaborative relationships with other community health professionals such as district nurses and GPs.
Most importantly, patients with extremely complex needs in the final 12 months of life have been able to receive care at home. In the six month period from October 2020 to April 2021, the Rapid Response team carried out 497 home visits. In the period from October 2021 to April 2022, this had increased to 747 home visits.
Hospital admissions have been reduced and more patients are dying in their preferred place. More patients are receiving the right response and the right intervention, at the right time.
The service won Hospice UK’s Innovation in Care Award for 2022.
Facilitators, challenges and advice
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Key facilitators
Employing paramedics has been vital to the success of the Rapid Response service, enabling the team to strike a balance between being responsive and maintaining the person-centred ethos of palliative care. The hospice was lucky to have a member of senior staff with a paramedic background who could help with initial recruitment.
The service has been developed incrementally, with hours being increased every 6 months. This has enabled the team to reshape the service and utilise existing resources according to need.
Rapid access to needs-based care was recommended in the Ambitions for Palliative and End of Life Care framework, which has helped Compton to evidence the importance of providing this service.
Challenges
There was some initial resistance to the new Rapid Response model, especially from staff whose roles were being changed. The hospice understood this and looked at different service models in response.
Tips and advice
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Be brave! Don’t be afraid to move away from the traditional models of service. Look at different models and decide what’s best for your hospice and your patients – no one size fits all.
It’s important for leaders to have an open ear, and be receptive to new ideas.
Future development
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The hospice is in the process of setting up a Virtual Ward so that patients requiring more specialist care can remain in their home environment.
