56 Exploring the impact of proactive in-reach by the supportive and palliative care team (SPCT) in the emergency department (ED) of manchester royal infirmary (MRI), a city centre teaching hospital

Introduction ED attendance during the final year of life is a significant challenge (Marie Curie, 2018). Models providing palliative care in the ED have shown numerous benefits (Wang et al, 2015). We embarked on a 6 month test of change providing specialist palliative care support to the MRI ED. Methods The SPCT ACP proactively in-reached into ED two afternoons a week for 6 months. Quantitative and qualitative data was collected to demonstrate our outcomes and compared with retrospective data collected prior to this intervention. Results Identifying patients presenting to ED who would benefit from SPCT input improved during the test of change with more than three times as many being identified by the SPCT ACP. Retrospective data showed 23.1% of patients had been identified in the last year of life by ED staff in comparison to 68% of patients by the ACP using prognostication tools. Patients presenting to ED often had a poor performance status (AKPS) of 50% or less, an initial median iPOS score of 24.5 and had an average of 3.13 admissions in the previous 12 months. Whilst many patients presented to ED appropriately with acute illness, SPCT input earlier on in their journey demonstrated reduction in symptom burden and improved quality of life reflected by a reduction of median iPOS score from 24.5 to 15.5 and patient experience stories. We were able to influence goals of care and subsequent hospital stay at an earlier point, demonstrated by a median reduction in length of stay of 17 days. The change also had positive impacts for ED staff, demonstrated by findings of the staff survey. Conclusion Proactive SPCT input into our ED positively impacts on patient experience and outcomes, supports an often stretched department and can reduce length of stay. Further exploration is needed to provide a sustainable model.