Martine Meyer’s scientific contributions

Background High fidelity simulation uses technologically-advanced manikins to simulate complex clinical situations to train professionals in technical skills and human factors in a multidisciplinary group. We have expanded the use of simulation training (SIM) to educate about end of life care (EOLC). Aims To evaluate the impact SIM training at Epsom and St Helier University Hospitals NHS Trust (ESTH) has on participant confidence, understanding and skills in EOLC and their perception of their role in end of life care. Methods A 1 day end of life care course was initially designed by The Simulation and Interactive Learning Centre at Guy’s and St Thomas’ Hospital and subsequently delivered twice at ESTH. The ESTH Team adapted the scenarios and held a further 6 courses from January 2015 to June 2016. Five scenarios covered subjects including the 5 priorities for care of the dying person, individualised care planning, cultural beliefs, the Mental Capacity Act, compassion and communication. The courses took place in the Simulation Centre, allowing a realistic ward or home setting, utilising a professional actor to enhance the scenarios. Participants were given pre and post course questionnaires with free text sections. Information from these was used to identify themes. Results 63 nurses and doctors of varying seniority attended the courses. Over half of the participants had worked in the NHS for at least a decade. Analysis of the data revealed that high fidelity simulation had a significant impact on the participants’ confidence, understanding and skills in EOLC and their perception of their role in EOLC. Additionally, the free text sections identified learning in patient centred care, communications skills, honesty and the importance of cultural factors. Conclusion Use of high fidelity simulation to teach EOLC had a positive impact on the participants. We are now looking to expand the course into community settings.

Background The need to facilitate dying patients spending time in their preferred place of care (PPC) was highlighted in the Department of Health’s Review of Choice in End of Life Care (2015). The Fast Track process (FT) ensures patients with a rapidly deteriorating condition can be discharged to their PPC in a timely manner with the appropriate support. Aim To identify and evaluate delays in the FT process at Epsom and St Helier University Hospitals NHS Trust (ESTH). Method A previous FT audit from April 2014-March 2015 identified 61 patients who died before being discharged to their PPC. Their clinical notes were obtained and data was collected on modifiable delays. Results Forty-seven complete sets of notes were obtained. The most significant delay was in completing and sending FT paperwork (30/47). Paperwork was not started for 3 patients and incomplete for 7 patients without explanation. Paperwork took 2–4 days to complete for 5 patients, 5–7 days for 12 patients and >8 days for 2 patients. Despite healthcare professionals identifying a patient was dying or deteriorating, a delay in decision to commence FT affected 20/47 patients. The decision to FT took 1–2 days for 3 patients, 3–4 days for 8 patients, and >8 days for 9 patients. Sudden unexpected death or deterioration was a factor in 8 patients. Family/patient indecision affected 8 patients. Delays within community services after funding was approved affected 5 patients. One patient had funding initially declined but agreed subsequently. Conclusion The most significant modifiable delays were in completing FT paperwork and in decision-making concerning FT. To reduce these delays, FT paperwork on the intranet has been reorganised, new prompts in the form of a sticker have been introduced and there is continuing education of clinical teams on decision making and FT discharge.