Further development of the rapid discharge integrated care pathway (RDICP) hospital to home

The ‘rapid discharge pathway’ (RDICP) was developed by the Palliative Care Team at the Royal and Broadgreen University Hospitals NHS Trust (RLBUHT) in response to an identified clinical need to enable imminently dying patients to die in their place of choice. The original RDICP was reviewed and refined in line with Version 12 of the generic LCP. Stakeholder meetings were held to gain consensus and to overcome bottlenecks/blockages in the system and the RDICP was launched in April 2008. Aim To undertake an audit of the first year of use of the amended pathway. An audit of outcomes for all 31 patients in 2008/9 who were transferred home supported by the RDICP was undertaken. The RDICP was used on 21 wards, within 5 directorates General Medicine (20) Care of the Older (2) Haematology (2) General Surgery (5) Renal Unit (2). Twenty-one patients had a diagnosis of cancer 61% were Male Mean time from discharge to death=8 days; median 5 days; IQR 2–10 days. No patients were re-admitted to the hospital prior to their death. The RDICP provides a structured and coordinated process to enable a dying patient to go home to die. It is crucial to the success of the framework that specialist palliative care services take a lead role in the use of this pathway. While numbers are small, the authors feel that this framework could be utilised by other health providers with local networking to achieve a rapid discharge of a patient to enable a home death. The RDICP is one means of facilitating choice at the end of life helping to ensure optimum care for dying patients and their families. However, while District Nurses support this process, families have to agree to provide the main bulk of care.