P-82 What level of medical input do hospice inpatients need and does this correspond to their need for specialist nursing input? a service evaluation in a uk hospice

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Abstract

Introduction

Though medical input to hospice inpatients is well-established, the evidence detailing the nature and level of medical staffing is lacking. Moreover, there are calls for hospices to develop less medical, more public health models.

Introduction

To facilitate nursing skill-mix changes, and broaden our ‘reach’ (to include ‘low-complexity’ patients), our inpatient unit was split equally into generalist nursing (GN) and specialist nursing (SN) beds. It was suggested GN-suitable patients would correspondingly have few medical needs. To facilitate medical workforce planning, we wanted to evaluate the medical needs across these potentially contrasting populations.

Methods

We developed a tool to detail the nature and intensity of medical interventions. We completed a 1 month prospective pilot, in a 28-bedded UK hospice, scoring perceived patient need each day.

Results

A tool reflecting overall medical need was generated; with 3-ratings (low, moderate, high), across 9 items (e.g. urgency, clinical complexity, trajectory, discord).

Results

284 patient assessments were completed (100%); the range of medical need for patients in GN beds was; low=78, moderate=41, high=14 and for SN beds; low=41, moderate=63, high=46. Concordance of medical and nursing complexity for GN patients=58% and SN patients=31%

Discussion

A spectrum of need for medical input to hospice inpatients was confirmed; the level fluctuated during a patient’s stay and high needs were not restricted to SN patients.

Discussion

The limited concordance between a patient’s perceived need for medical input and their suitability for SN or GN, questioned the wider applicability of this differentiation. There was a trend for lower medical input for ‘GN’ compared to ‘SN patients’. However, 41% of ‘GN patients’ had moderate or high medical needs and only 31% of ‘SN patients’ had high medical needs.

Discussion

The pilot tool appeared suitable for benchmarking the need for medical input; informing our workforce planning and warranting further evaluation, to include other care settings.

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