156 The role of medical provision in hospice day services – a review

Background Hospice day services are well recognised in palliative care provision. However, there is no standardised model for what structure such services take. For some, medical components are the focus, whereas others are orientated towards normalising life. At Severn Hospice, there has been a transition towards a new ‘Living Well’ concept: an 8-week assessment programme for patients with more complex palliative care needs. Patients attending this programme are reviewed by a doctor within the first 3 weeks, regardless of need. This has raised questions about whether this is appropriate. A review was undertaken to assess what medical needs patients attending the programme had, to inform discussion on the most appropriate model of medical provision moving forward. Methods A case notes review was conducted for all new patients attending the ‘Living Well’ programme between 01/06/18 and 31/05/2019 to assess what medical input was required. Results A total of 85 new patients attended the 8-week programme. Of these, 22 (26%) had no medical input. 63 patients (74%) had at least one medical interaction. Although 74% of patients were reviewed by a doctor, only 40 patients (47%) required any form of medical intervention (medication change, admission to IPU, liaison with GP, or referral to another service). Of these, 50% (20 patients) required only 1 intervention. There was a small cohort of 14 patients (16% of all patients) who required multiple interventions. In the 12-month period, 19 emergencies were encountered, which required rapid medical review. Conclusions It may not be appropriate to ‘medicalise’ all patients attending hospice day services if they do not derive any benefit from this interaction. Only a small proportion of patients with complex palliative care needs require specialist-level medical input. The challenge is identifying who these patients are and how to provide this medical input.