The importance of high quality End of Life Care has been emphasized during the Covid-19 outbreak, as death rates, particularly in older patients and those with complex care needs, has increased. Now advanced data modelling is helping to ensure that patients receive the right level of care and resources for as comfortable a death as possible.
A collaboration between PenCHORD, University Hospitals Bristol and Weston NHS Foundation Trust and the Universities of Exeter and Bristol has developed a model, the first to look at the provision of End of Life Care, to ensure that patients and staff have access to the resources they need at the time when they most need them.
PenCHORD’s Dr Daniel Chalk who lead the research collaboration said: “Much of the focus thus far, understandably, has been on preventing death, but given that people will die, and are dying, of the disease, it’s really important that we also ensure that resources are in place to give people and their families as comfortable a death as possible and minimise unnecessary distress at these most difficult of times.”
The team produced a computer model to predict the level of staff, equipment and medicines required for a specified level of COVID-19 End of Life Care. Data from Bristol, North Somerset and South Gloucestershire Hospital Trusts was then applied to predict the levels needed to meet demand similar to the peak level observed in the region in April 2020. The model identified the need for significant additional district nursing and care assistant time, local hospice support, syringe drivers and bundles of anticipatory medicines to meet the additional demands for providing End of Life Care to COVID-19 patients. As the pandemic developed the model was used to help commissioners to better plan End of Life Care resources.
Dr Charlotte Chamberlain, Clinical Lecturer in Palliative Medicine and Dan Hill Fellow at NIHR ARC West, commented:
“One of the strengths of this work is the ability to tailor the model to local need. It is imperative local areas can anticipate the additional resource, including staff, medication and syringe pumps, required to care for those who are dying during the COVID-19 pandemic. Relief of suffering at the end of life and support for their loved ones should be available to everyone. In a pandemic setting this requires anticipating demand to better prepare.”
The model has been made available online as free and open source software, meaning that any commissioning organisation or care provider can apply their own data, or develop the model. It can be adjusted to scale activity up or down as case numbers grow and declines. It also takes into account decisions about where a COVID-19 positive patient will be treated; whether at a hospital, in their own home or in a residential or care home.
This approach to predict resource requirements for End of Life care planning was adopted by Sirona, the main community care and health provider in Bristol, North Somerset and South Gloucestershire, to inform their planning for local outbreaks of COVID-19 and manage future outbreaks. It is also being used by a Palliative and End of Life Care Clinical Commissioning Group (CCG) to support pandemic planning.
The paper, Modelling palliative and end-of-life resource requirements during COVID-19: implications for quality care, was published in the BMJ Open in May 2021.