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Background Although the value of hospice volunteers is widely recognised, their role within the hospital setting is less established. An end-of-life volunteer companionship programme was established within an UK hospital to help support dying patients and their families ( provision of 'sitting' service and psychological support). Aim To assess the effectiveness of a two-day volunteer training programme. Methods Fifteen hospital volunteers were recruited due to length and experience of service; a further two through personal expressions of interest. A questionnaire (assessing knowledge, confidence about communication and support skills) was given: pre-training; 2 weeks post-training; and 3 months posttraining. Each question (n=17) had 5-point Likert-scale response options (1=strongly disagree, 5=strongly agree). Free text response boxes were provided.Two further cohorts of volunteers have been recruited (total n=30) and additional results are forth-coming. Results From the initial 17 volunteers, 14 were female with ages ranging from 19-70 years. Statistically significant improvements were seen across all knowledge scores post-training and were sustained after 3 months.

Aim To describe the benefits of early review by the Hospital Palliative Care Team (HPCT) for acutely admitted palliative patients. Background Over an 18 month period, the HPCT at a large University Hospital have attended the Medical Admissions Unit on a daily basis to pick up known patients and new referrals to the service, in order to provide early symptom control advice, to advise on appropriate treatment plans, and to begin early discharge planning for potentially complex patients. They have attended post-take ward rounds and introduced targeted palliative care teaching sessions within the Acute Assessment Areas. An electronic flagging system to alert both the admitting team and the HPCT of a patient's palliative status has also been trialled. Methods A retrospective audit of a 1 month period prior to implementation of this service was compared to the results of a similar audit performed 18 months following implementation. Results Prior to implementation, only 5% of patients referred to the team were identified in the Assessment Areas. The median total length of stay was 10 days, and on average patients were referred on day 5, half way through their admission. Following implementation, on average 25% of all referrals came from the assessment wards, all of whom were seen within 24 h of admission. Total new referrals to the team have increased by over 50%, suggesting the intervention helped to identify patients who would otherwise not have been referred. (Graphical representation of these results). Conclusion The service is felt to be of benefit by both the staff in the Assessment Areas and the HPCT, improving early access to services and advice for palliative patients, and improving clinical relationships. Further work is on-going to quantify any improvement in discharge outcomes for patients, including place of discharge and average length of hospital stay.

Background It can often be difficult for audit to make a sustained difference to clinical practice across and between organisations. The Merseyside and Cheshire Palliative Care Network Group was initially formed in 1995 and consists of individuals involved in specialist palliative care across the network who are based in community, hospice and hospital settings. The strength of the group lies in the multi disciplinary representation and the on-going enthusiasm of the various teams to participate in the projects. Method There are bi-monthly audit meetings with five audits and one planning session each year. The audits are a combination of new audits, regional audits (which look at previously audited topics) and non symptom control subjects. Results Each meeting attracts approximately 60 healthcare professionals plus an external expert. The presentation includes a literature review, audit results and a discussion around standards and guidelines. Regional audits complete the cycle by assessing group performance against previously developed standards. Dissemination is achieved at national and international level. Every 3 years, the guidelines are collated into a book which is part of the core formulary for the Network. It is now in the 4th edition and contains 43 different topics. Each chapter is referenced with levels of evidence and grades of recommendation. Conclusion The book acts as a resource for professionals and is applicable to those caring for cancer patients and other forms of advanced disease. It encourages the setting and monitoring of standards in palliative care and through the audit programme promotes clinical excellence in end of life care.