Case study 10

24/7 medical support in end-of-life care in Airedale

Coordinated care at end of life

A 24/7 telehealth and phone line service, Gold Line, was set up at Airedale General Hospital for senior nurses to take calls from patients thought to be within their last 12 months of life and their relatives.

The service, which runs across Airedale, Wharfedale and Craven, Bradford City and Bradford District,[1] was designed with input from healthcare professionals, patients, carers and Clinical Commissioning Group (CCG) representatives, with funding from the Health Foundation. The service design was provoked by using a fictitious ‘Day in the Life’ diary of a patient approaching the end of their life. This aimed to evoke an emotional response from those involved and takes into account the support needed by the people delivering the service.

The project was built within the Digital Care Hub infrastructure system already in place at Airedale. It used the same telemedicine service to hold key information, including future care wishes of these patients, in a template within the electronic records. This can be accessed by Gold Line and community staff, as well as GPs and district nurses. Several projects are serviced from the same Digital Care Hub meaning that costs are shared and they work in synergy with each other.

The project has provided high quality, coordinated care for a large number of people facing the last year of their lives and their carers. It has been recognised with several awards and staff are in talks with the CCG to expand the service model to the top 3-5% of people with the most complex care needs.[2]

Success factors

The success of the new telecare system may be attributed to:

understanding the needs of the patients, carers and senior nurses providing care

developing a realisable and shared purpose between all stakeholders

using personal dairies and PDSA cycles to motivate change

utilising existing digital infrastructure to ensure integration with other services

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[1] Bringing healthcare home final report, Airedale NHS Foundation Trust, 2016

[2] Gold Line service local evaluation, Year End Report April 2014 – March 2015, 2015

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