The Development of a Palliative Care Ward in Rotherham Hospital

Interviewee: Fiona Hendry, Consultant in Palliative Care, Rotherham NHS Foundation Trust

COVID-19 was expected to place a lot of demand on ITU space. Instead, many patients did not go to ITU but needed palliative care for which there was insufficuent capacity.

Approach/Methodology

Palliative Care is not usually thought of with an urgent context, but when the hospital recognised that palliative care space was going to become an issue it took a new proposal to senior leaders – converting a ward into a Palliative Care space.

As the pandemic started to intensify and patient numbers increased across Rotherham, the hospital reconfigured a ward to provide palliative care. Supported by the matron within Care of the Elderly, the team quickly turned one of their existing non-urgent care wards into a dedicated ward to provide care for palliative care patients.

The converted ward was busier than had been anticipated, and used more frequently than ITU. Sadly, over 100 deaths were recorded across a 2 month period. Despite the sad circumstances leading to its formation, the Palliative Care Ward was well-staffed and nurses were redeployed to the ward as required, ensuring high-quality and sensitive end-of-life care was given to patients.

Impact

Initially, some staff felt concerned about the possible risk of infection. Following dedicated training sessions (two per day) staff allocated to the ward were suitably reassured about stringent infection control measures and upskilled as necessary to work in this temporary Palliative Care setting. Nursing staff also found that they had more time to nurse patients and deliver high-quality personalised care. This was especially important at time of restricted visitor access for relatives and friends.

One of the key challenges was keeping families in touch with patients.  With visitations prohibited, staff provided opportunities for video and phone calls (between relatives and patients) to keep families in contact.

The interviewee is a consultant working predominately in the community with day-to-day dealings with the hospital. As visitations were heavily reduced, our interviewee and their clinical team were able to support in the palliative care ward instead. During the height of the pandemic the team was able to support with ward rounds, freeing-up hospital consultants for more urgent care.

The enhanced visibility of the Palliative Care Team within the hospital has been a catalyst for change within the hospital, helping to support continuous improvement. For example, the Accident and Emergency Department which would typically be the first point of contact for patients were then able to triage accordingly – and refer directly to the Palliative Care ward.

Palliative care now has far greater visibility in the hospital with an improved focus of its significance across the organisation.

Next Steps

Given the increasing pressures on ward space, this temporary ward for palliative care was closed and reverted back to an acute setting.

However, the trial has instigated an important conversation about the importance of palliative care and the use of wards, with an improved awareness of the needs of patients during all parts of their hospital care.

Key Learning Points

There appears to be an opportunity to enhance the palliative care pathway through a joined-up approach that supports acute and community care. Our case study suggests that there be may be ways of keeping palliative care patients out of hospital through more dedicated ward space and bypassing Accident and Emergency where clinically appropriate.

The benefits of changing the triage model for eventual palliative care patients offered a number of benefits including better patient experience, reduced waiting times, reduced pressures on ED and a reduction in clinical interventions – equating to a financial saving that can reinvested into other areas of the hospital.

There has been enormous recognition of the work across palliative care in which the team, temporarily assigned to provide a critical response, delivered a high-quality service during a pandemic.

A business case is now being developed to support this adaption as a permanent measure in the hospital.