Transitions of Care – Implementation of a county-wide Specialist Palliative Care (SPC) Single First Assessment (SFA) document in Ireland.

Background: The Cork Specialist Palliative Care (SPC) service in Ireland serves 5 public hospitals, a 44 bed SPC inpatient unit (IPU) and the largest county in the state with a community catchment area spanning 2500km2. A significant barrier to streamlining of patient care is the provision of care across many different healthcare providers operating in silos.

The purpose of the transitions of care quality improvement project (QIP) is to streamline and improve coordination

of palliative care across all providers in the county.

 

Objective: s

1)Collaborate with service providers to develop a Single First Assessment (SFA) document;

2)Implement the SFA at all points of entry to the SPC service;

3)Facilitate virtual transition of the SFA;

4)Compare first assessments before and after implementation of the SFA.

 

Approach: The Plan Do Study Act (PDSA) framework was adopted with a lean principles approach. A data protection impact assessment was conducted. A patient information leaflet was developed. A cross-site multidisciplinary working group included SPC representatives from acute hospitals, SPC IPU and community teams. Site-specific process maps summarised administrative, nursing and medical first assessment components. Consensus was reached for a ‘Single First Assessment’ document. Expert facilitator training sessions supported roll-out in November 2024. A cross-site Time and Motion study was conducted, pre- and post-SFA implementation, with stakeholder feedback. A centralised GDPR compliant virtual iCare platform was approved. Healthcare staff experiences were explored.

 

 

 

Results: SPC medical IPU admission time decreased by up to 43 minutes, community assessments between 19 and 29 minutes with and without prior SFA upon patient review across Time and Motion cycles. An average reduction of 4 administration and 3-13 nursing review minutes with SFA available upon patient review were measured in one acute setting. SFA was acceptable to patients and healthcare professionals.

 

Implications: A shared vision, knowledge of current local practice and creative problem solving promoted positive staff engagement and stakeholder buy-in. The SFA reduces duplication, facilitates safe transition of pertinent clinical information across care settings and lessens patient burden. Cross-site working relationships were reinforced. Exploring patient and family experiences will allow a 360-intervention insight.