By Dr Simon Tavabie – Palliative medicine registrar – Marie Curie Hospice Hampstead @SimonTavabie
Football, I understand, is a popular pastime and I’m told that people are rather missing it at the moment due to the COVID-19 pandemic. I’ve been warned that, given my abject lack of understanding, I’m unlikely to be able to write a blog focussing on a football analogy but I’ve (perhaps unwisely) decided to give it a go. Bear with me…
A few days ago I was watching a football match (disclaimer – this is not true) and I noticed that alongside the half and full-time debriefs and strategising, there is a constant stream of impassioned feedback from the coaches on the side-lines. I was minded of the recent project ‘Hospital Deaths Dashboard’ conceived and carried out down in Brighton1.
End of life care is audited on an annual basis coordinated by the National Benchmarking Network2. This undertaking evaluates (in great detail) aspects of end of life care, allowing for large scale strategy change and an understanding of regional variations and where things can be improved. While useful in a number of ways, it feels very much ‘removed from the game’ like the half/full time huddles or even the post-match analysis with the chap with the big ears.
On a very local level, the most useful immediate input is the coach shouting from the side-lines. Whether you’re focussing on the reliable care of the elderly team in midfield that needs praise; the ambitious acute medics on the wing that need some guidelines; or that team that goes unnamed in every hospital in goal who refuse to concede that patients do die, and that needs support in accepting this – timely, directed feedback is invaluable.
Hospital based specialist palliative care teams are most often advisory in nature and can provide live input through clinical advice, staff education and guidance of quality improvement work targeting bettering the experiences of people dying as inpatients. However, to do this effectively they need up to date information and data to identify areas of need and monitor progress, otherwise they’re just shouting at the team while wearing blindfolds.
Back to the seaside now, where we designed a dashboard and collection methodology for the continuous reporting on the quality of end of life care so that we could pick out areas that needed improvement and act fast. We have found this to be useful in providing a visual and timely representation of this data in a clear way so that we better understand how it is to die in different areas around the trust. The dashboard is based on guidance and recommendations already out there – five priorities of care of the dying person, elements of the RCPs mortality review kit and particular areas of interest such as clinical frailty scoring and treatment escalation planning3,4. Already, we’ve found it useful in guiding QI such as work around our care plan for the dying person and informing improvements during the COVID-19 pandemic (with many more ideas forming with each review)5. We feel this approach could be useful in helping other hospitals in their data collection so that their work can be more targeted, up to date and better able to improve people’s experience of end of life care.
NB: Now, the eagle eyed fans of both football and palliative medicine may have taken offence to the idea of the palliative care team on the side-lines rather than the pitch when it comes to end of life care. It is my uneducated understanding that these coaches, due to their great experience and skill, are sometimes ‘subbed’ on when there’s a particularly difficult goal to score. I choose not to look this up as it might undermine my otherwise watertight analogy.
References:
- Minton O, Ede C, Bass S et al. Hospital deaths dashboard: care indicators. BMJ Support Palliat Care 2020, in press (DOI: 10.1136/ bmjspcare-2020-002223)
- NHS. National audit of care at the end of life (NACEL). Available: https://www.nhsbenchmarking.nhs.uk/nacel[Accessed 10 Jun 2020]
- Leadership Alliance for the Care of Dying People. One chance to get it right. Available from https://assets.publishing.service. gov.uk/government/uploads/system/uploads/attachment_data/ file/323188/One_chance_to_get_it_right.pdf [Accessed 10 Jun 2020].
- Royal College of Physicians. Mortality toolkit: implementing structured judgement reviews for improvement. Available: https://www.rcplondon.ac.uk/guidelines-policy/mortality-toolkit-implementing-structured-judgement-reviews-improvement[Accessed 10 Jun 2020].
- Tavabie S, Bass S, Stewart E et al. Care of the dying person before and during the COVID-19 pandemic: A quality improvement project. RCP Future Healthcare Journal 2020, in press (DOI: https://doi.org/10.7861/fhj.2020-0047