P-221 A tale of two hospices: the development of a unique service model of hospice consultant support

Background The Association of Palliative Medicine of Great Britain and Ireland (APM) state ‘Palliative medicine is at a turning point in terms of delivering new service models’ (Workforce Committee of the APM, 2019). Ardgowan Hospice has had consultant recruitment challenges. Explanations include geography and no Clyde palliative trainee placements. There was an estimated 56 vacant UK consultant posts in 2018. Too few trainees and the removal of the CESR process means the number of prospective consultants is insufficient for service demand. A changing teaching curriculum and seven-day working creates concerns for junior-tier rotas which will impact the consultant on-call. With an ever-increasing demand of services, innovative staffing solutions are required so palliative medicine can continue to flourish in hospitals, hospices, and community. Ardgowan Hospice (AH) and St Christopher’s Hospice (SCH) developed an innovative service model for hospice consultant support. Aim To develop and evaluate a remote consultant service model. Method Quality improvement methodology enabled the design, development, and evaluation of remote consultant framework. Plan Do Study Act (PDSA) cycles, cause and effect analysis, field analysis, survey, and audit were all utilised. Results In 2019, PDSA cycles showed that it was imperative that shared policies, guidelines, and protocols were established to provide seamless patient care. Quality improvement analysis highlighted important themes for cohesive working. These were team-work, flexibility and adaptability, continuity of care, as well as high quality handovers. Innovative IT solutions were developed to provide efficient communication within clinical governance structures. A 2021 audit showed 11 communications with SCH about 12 patients over a three-months period. This facilitated appropriate senior advice when required. A 2021 survey was conducted. The average satisfaction score was 8.5/10. A number of qualitative themes were identified. Conclusion AH and SCH have shown that by completing a quality improvement project that it is possible to create an innovative remote consultant service provision model.