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:
Introduction
Section 1: prepare
Section 2: assess and diagnose
Section 3: plan
Section 4: treat
Section 5: evaluate
Section 6: sustain
Section 7: further resources
Cover
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
2. Section 5
Core metrics
These core metrics have been developed to
inform the progress of implementation of The
route to success in end of life care – achieving
quality in acute hospitals and to support the
model of service improvement.
They have been developed following
consultation with the 26 first wave hospital
Trusts involved in the programme. Other locally
developed metrics may also be used to inform
and will contribute to overall reporting. Reports
are to be collected at the beginning, middle
and end of the implementation period.
The core metrics are designed to inform at
two levels within the organisation:
1. Reporting at ward level
2. Reporting at executive Trust Board level
Reporting at ward level
The core metrics developed at ward level
are those that link directly with the five key
enablers identified in Section 3 of this guide.
These are Advance Care Planning, Electronic
Palliative Care Co-ordination Systems (EPaCCS),
the Rapid Discharge Home to Die Pathway,
the AMBER Care Bundle and the Liverpool
Care Pathway. These enablers can most
inform the productive ward model of service
improvement.
Using the metrics in the first instance to
assess your baseline will enable wards to
develop a plan for service improvement
according to individual starting points,
priorities and agreed time scales.
2
Reporting at executive Trust Board
level
Metrics for the executive Trust Board level are
based firstly on the ward core metrics and
secondly are aligned with the hospital quality
markers from the National End of Life Care
Quality Assessment (ELCQuA) Tool:
www.elcqua.nhs.uk
How can the core metrics improve
care?
As a national programme to improve end of
life care in acute hospitals, these core metrics
can support improvement in care in two ways:
1. They can identify areas of best practice
which can then be highlighted within
the programme and disseminated to
speed up shared learning and service
improvement
2. It is anticipated that the aggregated data
from the participating sites will clearly
demonstrate service improvement over
time.
How often will the core metrics be
collected?
In order to keep in line with existing Trust
quarterly reporting processes as far as possible,
it is planned to collect metrics at ‘baseline’
(November 2011), ‘midpoint’ (June 2012) and
‘endpoint’ (November 2012). Any data that is
submitted into the national programme will
not be reported or published at an individual
Trust level.
3. The route to success ‘how to’ guide
Development of the core metrics
One of the outcomes of this initiative will be to
inform the development of the most relevant
metrics both at ward level, and at Trust Board
level. This will further inform the roll out of The
route to success. Alongside the NICE end of
life care for adults quality standard, it will also
influence the updating of the national ELCQuA
indicators for hospitals.
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
Dr Julia Verne, director of the South West
Public Health Observatory, explains the
importance of the local data available via the
National End of Life Care Intelligence Network,
and how it can be used for developing and
monitoring services.
MEDIA
CONTENT
To view this podcast please visit:
tinyurl.com/acute-rts-howtoguide
Andy Pring, senior analyst at the South
West Public Health Observatory, provides a
demonstration of how the National End of Life
Care Intelligence Network’s online profiles can
be used to analyse local data and trends.
3
4. Section 5
Core metrics: Trust Board
Organisational baseline data:
Number
1. Number of beds in Trust
2. Number of adult wards in Trust
3. Number of eligible wards (e.g. more than
five deaths per year) for The route to success
improvement programme
4. Number of deaths per year in the Trust
5. Number of people who die in the Trust’s
catchment area per year
6. Number of people who die in their usual place
of residence in Trust catchment area (QIPP KPI)
7. Number of people in the Trust discharged on
the Rapid Discharge Home to Die Pathway in the
last 3 months
Please record or attach any end of life care CQUINS,
PROMS and KPIs currently in use in your Trust
Please record or attach any ‘best practice’ models
of end of life care education and training initiatives
in your Trust
Trust Boards may also wish to consider an additional proposed QIPP key performance indicator,
which is:
To reduce the number of hospital admissions which end in death of eight days or more.
This indicator must be based on clinical need, quality of care and individual’s preferences.
4
6. Section 5
Core metrics: Trust Board (continued)
Please complete below the number of eligible wards (e.g. more than five deaths per year) that
have implemented the five key enablers or equivalent and the number planning to implement
during the next 12 months.
Enablers:
Baseline
Midpoint
Endpoint
No. of wards
implemented
by Nov 2011
Planned
no. of wards
implemented
by June 2012
Planned no. of
wards
implemented
by Nov 2012
Advance Care Planning model (ACP)
Integration within an Electronic Palliative
Care Co-ordination Systems (EPaCCS)
AMBER Care Bundle
Rapid Discharge Home to Die Pathway
(e.g. anticipated prognosis – hours/days)
Liverpool Care Pathway (LCP)
1. The Trust has an action plan for the delivery of high quality end of life care, which
encompasses people with all diagnoses, and is reviewed for impact and progress
Baseline
Comment on next steps
6
Plan not
developed
Plan partially
developed
Plan in place
and post
implementation of
the strategic plan
for impact and
progress
RED
Numerical indicator:
The Trust has an end of life care action plan
which feeds into a locality wide strategic
plan for end of life care
AMBER
GREEN
7. The route to success ‘how to’ guide
Core metrics: Trust Board (continued)
2. Promote end of life care training opportunities and enable relevant workers to access or
attend appropriate programmes dependent on their needs
No curriculum
evidenced
Curriculum
being developed
against Trust
Training Needs
Analysis
Curriculum
evidenced based
on Trust Training
Needs Analysis
RED
Numerical indicator:
Identification of end of life care training
needs of staff and training is in place to
meet this
AMBER
GREEN
Baseline
Comment on next steps
3. Monitor the quality and outputs of end of life care and submit relevant information for
local and national audits
Minimal audit
and review
Infrequent audit
and review,
actions not
followed
Regular and
comprehensive
audit, including
participation in
National Care of
the Dying Audit –
Hospitals (NCDAH)
RED
Numerical indicator:
Identification of end of life care audit
programme in Trust
AMBER
GREEN
Baseline
Comment on next steps
7
8. Section 5
Core metrics: Ward
Baseline data:
Number of people
Number of admissions per year on the ward
Number of deaths per year on the ward
Red Level 0 Amber Level 1 Yellow Level 2 Blue Level 4 Green Level 5
1. Advance Care Planning (ACP)
Indicator:
Ward
implementation
of ACP model
Midpoint
Endpoint
8
The ward has
plans in place
to implement
ACP model
The ward has
an education
and training
programme
for
implementing
ACP model
The ward is able
to demonstrate
implementation
of ACP model
The ward has
embedded
and sustained
the use of
ACP model
RED
Baseline
The ward
has not
implemented
ACP model
AMBER
YELLOW
BLUE
GREEN
9. The route to success ‘how to’ guide
Core metrics: Ward (continued)
2. Electronic Palliative Care Co-ordination Systems (EPaCCS)
Indicator:
Ward
implementation
of EPaCCS
The ward
has not
implemented
EPaCCS
The ward has
plans in place
to implement
EPaCCS
The ward has
an education
and training
programme
for
implementing
EPaCCS
The ward is able
to demonstrate
implementation
of EPaCCS
The ward has
embedded
and sustained
the use of
EPaCCS
RED
AMBER
YELLOW
BLUE
GREEN
The ward
has not
implemented
AMBER
The ward has
plans in place
to implement
AMBER
The ward has
an education
and training
programme
for
implementing
AMBER
The ward is able
to demonstrate
implementation
of AMBER
The ward has
embedded
and sustained
the use of
AMBER
RED
AMBER
YELLOW
BLUE
GREEN
Baseline
Midpoint
Endpoint
3. AMBER Care Bundle
Indicator:
Ward
implementation
of AMBER
Baseline
Midpoint
Endpoint
9
10. Section 5
Core metrics: Ward (continued)
4. Rapid Discharge Home to Die Pathway (RDP)
Indicator:
Ward
implementation
of RDP
The ward
has not
implemented
RDP
The ward has
plans in place
to implement
RDP
The ward has
an education
and training
programme
for
implementing
RDP
RED
AMBER
YELLOW
BLUE
GREEN
The ward
has not
implemented
LCP
The ward has
plans in place
to implement
LCP
The ward has
an education
and training
programme
for
implementing
LCP
The ward is able
to demonstrate
implementation
of LCP
The ward has
embedded
and sustained
the use of
LCP
RED
AMBER
YELLOW
BLUE
GREEN
The ward is able
to demonstrate
implementation
of RDP
The ward has
embedded
and sustained
the use of
RDP
Baseline
Midpoint
Endpoint
5. Liverpool Care Pathway (LCP)
Indicator:
Ward
implementation
of LCP
Baseline
Midpoint
Endpoint
10
