The success of the 2009/10 pilot of the Acute Palliative Care Unit in Ninewells Hospital helped prove the need for hospital specialist palliative care.

In 2007, Tayside Health Board approved the development of an acute palliative care unit. The pilot programme was possible through a generous endowment from an individual benefactor – on the understanding that NHS Tayside established a permanent unit if it proved to be a success.

This pilot program at Ninewells Hospital, Dundee was the inspiration for PATCH.

Overview of the program

100 patients were admitted to a small unit with a dedicated palliative care nurse and three beds. The program made a commitment to provide:

• Short­stay specialist beds for intensive palliative care 24/7
• A dedicated multi­professional team to integrate palliative care into mainstream medical care that was not deferred until the last few days of life
• Safe, rapid discharge for patients who prefer to be in their own homes
• An education resource for the hospital
• Research and audit to demonstrate the benefit of specialist palliative care

Success

Pain and distress were rapidly improved by providing more intensive, specialised palliative care in a small on-site facility. The pilot programme also influenced the understanding of palliative care in the hospital, demonstrating what it offered patients, family and staff.

I was able to have time with particular nurses and get to know them

Patient with severe anxiety & nausea

For the 70 patients in whom admission and 48 hour measurement was possible, the reduction in symptom burden was highly significant.

77% patients were discharged from the unit: 32% went home, 26% to a hospice or community hospital. 36% of patients were seen by occupational therapy, all within 2 working days showing the benefits of an intensive team approach.

I woke up and had no pain…the last time I had no pain was 3 months ago

Patient who got home

There were numerous factors that contributed to the success of the pilot:

• The commitment of staff in numerous specialities such as specialist palliative care, chaplaincy, physiotherapy, social work and occupational therapy.
• Senior management support – allowing innovation to flourish and encouraging a model of care that is not only first in Scotland but for the UK.
• The agreement from NHS Tayside in August 2009 to continue the initiative, expand the number of beds and make the facility available to all hospital patients.

This initiative has helped patients and their families enormously and has brought together acute surgical practice and palliative practice. This is thouroughly recommended as a model for the future.

Royal College of Surgeons of Edinburgh, Dec 2009

Further information

This article outlines the findings from the following report and subsequent journal publication. A presentation by Amy Geddes, a medical student, reports findings five years after the unit was established.

Ninewells Acute Palliative Care & Symptom Control Unit- Report of the 2009-10 pilot

The initial report on the pilot unit for the first 100 patients and their families admitted from 5.2.09 – 31.12.09. This report gives the background behind the pilot, an overview of the program and the clinical results.

Short-stay, specialist beds in a UK teaching hospital as a model to integrate palliative care into the acute hospital culture

Paterson, F., Buchanan, D., MacIvor, F., Baker, L. and Levack, P. (2012) J R Coll Physicians Edinb, (42) pp.8–14, doi:10.4997/JRCPE.2012.103.

Presentation: The Effectiveness of an Acute Palliative Care Unit (APCU)

Five years after the unit was established, the results from 355 patients are reported by Amy Geddes, a medical student who presented the data (and won the presentation prize) at the 2014 Strathcarron Conference – New Directions in Palliative Care.