End of Life Care - Rapid End of Life Discharge

The doctors and nurses will have explained that there has been a change in your relative’s or friend’s condition, and they believe the person you care about may be in the last hours or days of their life.

Your relative or friend may have shared a wish to be at home, in a care home, or in a hospice at the end of their life. In some cases, you as a family member or friend may have expressed this on their behalf. We can’t imagine how difficult this time is, and staff will support you and work with you to try and fulfil these wishes.

Things to think about and discuss before discharge can take place

• What is most important to you and to your relative or friend at this time?
• Any concerns or expectations you may have
• What care and support are family or friends able to provide
• What care and support you are expecting from the doctors, nurses and community teams
• Whether any special equipment will be needed at home, in a care home or in a hospice
• What medication will be needed and how it will be given

Once your questions, concerns and expectations have been discussed we will aim to arrange the discharge as soon as possible. The discharge will usually take place later the same day or the following day.

If the hospice is a preferred place of care, then a referral will need to be made to the relevant hospice by the hospital. The hospice team will then review the referral and whether admission is possible. Due to the limited number of beds, this can sometimes involve a waiting list, but the hospital team will keep you updated on this.

What happens now?

The ward doctors and nurses will assess your relative’s or friend’s needs and will involve the discharge or transfer of care team, along with any other relevant services, to help plan a safe discharge.

This assessment may identify the need for special equipment. The team will arrange this, but it may not always be available on the day of discharge. A relative or friend may be asked to collect the equipment and take it to the discharge address.

If oxygen is needed, this will be arranged for you. It will be delivered to the discharge address on the same day.

Any medication your relative or friend needs will be provided before they leave the hospital. This may include injectable medicines or medicines given through a syringe pump. The team will explain what these are, why they are needed, and how they will be given.

If your relative or friend is going home or to a care home, support will be arranged from the services they need. This may include District Nurses, their GP, the Community Specialist Palliative Care Team, and local hospice or charity services. Their needs will be assessed, and the appropriate visits will be organised.

In the community District Nurses are available on call 24 hours a day, 7 days a week. However, it is important to understand that a nurse will not be with your relative or friend all the time. If you notice any symptoms, contact the community nurses. A District Nurse will visit as soon as possible to assess the symptoms and provide appropriate treatment. Sometimes there may be a short wait depending on their workload, but they will attend as quickly as they can.

An ambulance will be arranged to take your relative or friend to their discharge destination. The ambulance will usually arrive within 4 hours of booking. It maybe possible for someone to travel with your relative or friend in the ambulance.

For most people being discharged for end-of-life care, a decision about what should happen if their heart stops will already have been made and discussed in advance, where possible, with the person themselves and/or with their relative or friend. In these situations, the agreed plan would be to allow a natural death rather than attempt resuscitation. This decision is recorded on a form (often referred to as a DNACPR form) that the ambulance crew will need to see, and it will travel with your relative or friend to their discharged destination.

Your relative or friend will be discharged with important documents for the health care professionals who will be supporting them. These will be placed in an envelope and given to the nurses looking after them or marked ‘District Nurses’ for those in the community.

Medical Examiner

When someone dies in hospital or in the community, their care is reviewed by the Medical Examiners unless the death needs to be reported to the Coroner. The health care professionals looking after your loved one will explain this to you before arranging a rapid discharge.

A Medical Examiner is a consultant or senior doctor who works independently from the Northern Care Alliance. The purpose of the Medical Examiner (ME) system is to provide an independent and thorough review of all deaths that are not reportable to the Coroner. This means the ME will look closely at the patient’s notes and the care they received. Their role is to make sure that the information recorded on the Medical Certificate of Cause of Death (MCCD) is accurate.

When you are contacted by the Medical Examiners Service, you will have an opportunity to ask any questions and provide any feedback or concerns you may have.

Are there any risks involved in my relative/friend being discharged?

Sometimes a person’s condition can change, and this can affect how long care and support may be needed for at home. They may remain stable for longer than expected, or they may deteriorate and die sooner than expected.

Despite all our best intentions, your relative’s or friend’s condition may change rapidly. If this happens, we may not be able to go ahead with the planned discharge.

There is also a risk that if their condition changes very quickly, they may die during the journey home.
 
If your relative or friend dies during the journey home or to a care home, the ambulance crew will talk to you about what will happen next.

If your relative or friend is being discharged and they have a syringe pump in place for symptom management, it may need to be removed before they leave the hospital. Arrangements will be made for the district nurses, hospice nurses or nursing home nurses to reconnect a syringe pump as soon as possible once they arrive home or in their care home.

Your relative or friend can be given medication prior to leaving the hospital to ensure a safe and comfortable journey.

If the doctors and nurses have explained that your loved one’s death needs to be reported to the Coroner, they may need to return to the hospital so that the Coroner can carry out the necessary investigations. You will be informed if this is required, and the community team will guide you through what will happen next.

Useful contact details

Discharge/Transfer of Care Team:     

District Nurses:

Daytime ___________________________________________________________________________________________     

Evening/weekend/Bank holidays ____________________________________________________________________     

Care agency (if applicable) __________________________________________________________________________    

Discharging ward ________________________________________________________________________________     

Hospital Palliative Care Team ______________________________________________________________________

Community Palliative Care Team (if needed) ________________________________________________________ 

GP Surgery ______________________________________________________________________________________     

GP ‘Out of Hours’ ________________________________________________________________________________     
(evening/weekend/bank holidays)

Equipment Services

For any concerns regarding equipment repair or collection, please contact your local equipment services:
Salford - 0161 206 7016
Bury - 0161 253 6858
Oldham and Rochdale - 0161 344 0482