O-12 Hospiscare escalation in activity tool (HEAT) – balancing safe staffing with palliative patient complexity

Background

When the UK went into COVID-19 lockdown, we had no foresight into how our referrals would change in the forthcoming years. Average time on caseload has reduced to eleven days (Hospiscare. 2023. Clinical Quality Presentation Q1) and increases in complexity are evident (All-Party Parliamentary Group. The Lasting impact of COVID-19 on death, dying and bereavement. 2023). This meant increasing concern for patient safety and staff wellbeing.

Aim

To identify and design a hospice specific tool that considers safe staffing alongside patient complexity to always ensure clinically safe and effective patient care.

Methods

Hospiscare worked with an independent company to develop a risk management framework alongside clinical acumen that triangulates safe staffing, patient complexity, and demand on the service. For the purposes of planning, four levels of RAG escalation were identified. Each team input their staffing levels daily, and dependency data is extrapolated from our EPR. An email is then sent to all clinical staff ensuring an awareness of our organisational level and actions can be taken to mitigate any risk in real time. If a BLACK status is recognised, a prepared statement is utilised by teams to communicate with external colleagues.

Results

From commencing the HEAT tool, we have been able to extract data which demonstrates pressure points enabling us to be agile and responsive as a service. This includes: Actively managing staffing levels from 70% to 20% in the RED during times of pressure within our clinical service. Gaining an understanding of the complexities of our patients on any day. For example, by utilising OACC measurements we identify that 80% of our patients are either unstable or deteriorating within our caseload. In addition we can monitor fluctuation in activity levels across our clinical coordination centre, monitor bank usage and understand on a daily basis level of referrals coming into the organisation.

Conclusion

By utilising HEAT, we have greater overview and are able to respond quickly to changes in staffing and demand within our service using the data to make evidence-based decisions. By considering information from this tool, we have been able to safely make temporary changes in operational provision and consider future service need through ICB discussions.