Could it have been predicted? A retrospective analysis of the last year of life for people who died whilst in an intermediate care centre.

Objectives: Intermediate care centres (ICCs) exist in the UK to bridge between acute hospital and home for those with rehabilitation needs. A national study shows 25% of ICC in-patients died within a year of admission. High quality end-of-life care includes early conversations with a person and their loved ones about what matters to them; timely identification of those who are likely to be nearing the end of their life is key. Methods: This retrospective quantitative review of 98 patient notes reviewed deaths in one NHS trust, comparing 50 deaths in the acute hospital and 48 in the ICC. Data included frailty score, previous hospital admissions, specialist palliative input and conversations between professionals, patients and their loved ones. Supportive and Palliative Care Indicators Tool (SPICT) scores were used to identify those likely to have a poor prognosis. Results: Results showed statistically significant differences between the groups. The ICC cohort were older with higher clinical frailty scores. They were less likely to have previous hospital admissions but more likely to have poor prognostic features on final admission. Despite this, the possibility of deterioration was discussed them less frequently than the acute hospital cohort, and fewer saw the Palliative care team. Conclusion: This data suggests support is needed in ICCs to recognise those likely to be nearing end-of-life. One challenge is patients are more likely to be seen as 'well' in a rehabilitation focused environment. This paper suggests a 'proactive approach' trial using SPICT for ongoing assessment of ICC in-patients supporting identification of a deteriorating person and avoid missed opportunities for key conversations.

Impact of bedside ultrasound on care in specialist palliative care units: a qualitative study.

OBJECTIVES: To explore the experiences of palliative care doctors regarding the clinical impact of ultrasound in specialist palliative care units (SPCUs). METHODS: The study adopted a qualitative research design using semistructured interviews and a reflexivity journal. Six participants were recruited through purposive and snowball sampling. Findings were analysed using framework analysis. RESULTS: Analysis used four predetermined themes: (1) practicalities, (2) clinical indications, (3) impact on patient care and service provision and (4) governance and training. Analysis identified a relationship between procedural confidence and use of ultrasound. CONCLUSIONS: Our study provides information for understanding the current use and limitations of ultrasound in SPCUs. Ultrasound leads to safer practice, especially when performing invasive procedures such as paracentesis. Development of standards around the use of, and training of staff undertaking ultrasound in specialist palliative care, are recommended.