Route to success - assess and diagnose


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This 'how to' guide builds upon the overarching framework set out in The route to success in end of life care - achieving quality in acute hospitals, published in 2010. The route to success highlighted best practice models developed by acute hospital Trusts, providing a comprehensive framework to enable hospitals to deliver high quality care to people at the end of life.
This 'how to' guide aims to help clinicians, managers and directors implement The route to success more effectively, drawing on valuable learning from the NHS Institute for Innovation and Improvement's Productive Ward: Releasing time to care™ series.

This guide contains individual sections that can be worked on in any given order, dependent upon the individual hospital and its current end of life care provisions. These can be downloaded below:

Section 1: prepare
Section 2: assess and diagnose
Section 3: plan
Section 4: treat
Section 5: evaluate
Section 6: sustain
Section 7: further resources
It places emphasis on existing 'enabling' tools and models, which support and follow a person-centred pathway. These are Advance Care Planning, Electronic Palliative Care Co-ordination Systems (EPaCCS), AMBER Care Bundle, Rapid Discharge Home to Die Pathway, and the Liverpool Care Pathway.

Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013

Published in: Health & Medicine
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Route to success - assess and diagnose

  1. 1. Section 2 The route to success Assess and diagnose
  2. 2. Section 2 Assess and diagnose There are numerous sources of information available to help you benchmark your current position, for example: Your Trust’s existing key performance indicators relating to QIPP, PROMs and CQUINs for end of life care The benchmark developed from the collated Strategic Health Authority returns indicating what is collected by Trusts currently against PROMs, CQUINs and QIPP could provide a useful marker Jargon , y, Innovation QIPP – Qualit d Prevention Productivity an programme utcome nt Reported O ROMs – Patie P Measures r missioning fo CQUINs – Com amework novation fr Quality and In Use your multidisciplinary team to enable identification and overview of complaints related to end of life care Review of clinical coding Data from the National End of Life Care Intelligence Network’s End of Life Care Profiles will inform how you are doing to enable you to prioritise and develop your Trust’s end of life care quality improvement dashboard1 Disease specific reports from the National End of Life Care Intelligence Network2 The end of life care quality assessment tool (ELCQuA)3 The NICE end of life care for adults quality standard4 National Council for Palliative Care reports on the palliative care workforce.5 3 4 5 1 2 2
  3. 3. The route to success ‘how to’ guide TOP TIP hat good looks Think about w e 1 of this guid e from Section lik igures 1 and 2 nd consider F a ese g pages. Use th on the followin y what is alread to help identify your Trust. happening in 3
  4. 4. Section 2 Figure 1: Key drivers for excellence in end of life care Primary drivers Quality in acute hospitals Key drivers highlight the process for moving toward excellence: Person centred/ family care Excellence in end of life care Leadership Outcome Measures Care that is compassionate, equitable, reliable, improves the care experience, makes best use of resources. Full compliance with national quality markers. Reduction of harm. 4 Effective teamwork Safe, effective reliable systems Measurement
  5. 5. The route to success ‘how to’ guide Secondary drivers 1. Engage individuals and families as active partners in care 2. Open transparent communication that is respectful of preferred priorites for care and preferred place of death 3. Involve families in the physical care of their relatives 4. Involve families in improvement teams 5. Facilitate user feedback within service improvement 6. Care after death 1. Leadership explicit with organisation’s Trust Board agenda 2. Senior management objectives 3. Clinical champions for end of life care 4. Competent trained staff – partnership between hospital palliative care teams/long term conditions 5. Culture of compassionate care by staff caring for individuals approaching end of life 1. Agreed standards for effective communication with individual and family 2. Effective identification and development of management plans 3. Discharge liaison/Community/GPs/Ambulance/OOH/Social care 4. Adopt common end of life care Pathway language – e.g. The route to success for acute hospitals 1. Implement end of life care good practice models – productive series, advancing quality, clinical audit 2. Use of agreed prognostic indicator guidance 3. AMBER Care Bundle in use across Trust 4. Advance care planning, Preferred Priorities for Care, Do Not Attempt Cardio-Pulmonary Resuscitation, Liverpool Care Pathway 5. Electronic palliative care co-ordination system (EPaCCS), rapid discharge home to die pathway 6. Symptom management 1. Safe and effective care with regular review of Serious Untoward Incidents, complaints etc 2. PROMS 3. National bereavement survey (VOICES) 4. The route to success dashboard – each trust to develop own utilising ‘how to’ guide metrics for wards and boards 5
  6. 6. Section 2 Figure 2: The end of life care pathway for acute hospitals The six steps of the end of life care pathway are not discreet or incremental but interact and overlap along the person-centred pathway. Most hospitals will be providing some of this care, for some people, some of the time. Where are your gaps and what can you do to fill them? Step 1 Discussions as the end of life approaches honest communication triggers for discussion Step 2 Assessment, care planning and review l Open, l Conduct l Identifying l Agreed l Advance l Assessing care planning. a holistic asessment care plan and regular review of needs and preferences l Advance needs of carers care planning. Step 3 Co-ordination of care l Strategic co-ordination working with primary and community health services, ambulance/ transport services and social care l Co-ordination of individual care l Discharge l Rapid planning discharge home to die l Fast track continuing health care. High quality end of life care making best use of resources Senior clinical descision-making close to the patient and an appropriately trained and supported workforce Strong governance including board oversight and senior management engagement © National End of Life Care Programme (2010) adapted from the End of Life Care Strategy (Department of Health, 2008) 6
  7. 7. The route to success ‘how to’ guide Step 4 Delivery of high quality care in an acute hospital environment to specialist palliative care advice around the clock Step 5 Care in the last days of life l Dignified l Identification l Access l Review l Specialist hospital palliative care team l Access to spiritual care l Access to tailored information. of the dying phase of needs and preferences for place of death l Support for both the individual and carer l Recognition of wishes regarding resuscitation and organ donation. Step 6 Care after death l Recognition that end of life care does not stop at the point of death l Timely verification and certification of death or referral to coroner l Care and support of carer and family, including emotional and practical bereavement support. High quality end of life care making best use of resources Senior clinical descision-making close to the patient and an appropriately trained and supported workforce Strong governance including board oversight and senior management engagement Related references: Improving outcomes guidance in supportive and palliative care. NICE 2004 Treatment and care towards the end of life: good practice in descision making. GMC 2010 7
  8. 8. Published by the National End of Life Care Programme ISBN: 978 1 908874 04 7 Programme Ref: PB0005 A 02 12 Publication date: Feb 2012 Review date: Feb 2014 © National End of Life Care Programme (2012) All rights reserved. For full Terms of Use please visit or email In particular please note that you must not use this product or material for the purposes of financial or commercial gain, including, without limitation, sale of the products or materials to any person. Supported by the NHS Institute for Innovation and Improvement