"Use of the GSF PIG tool in different settings and with patients with different conditions has been shown to increase early identification of patients, leading potentially to more proactive care."
O’Callaghan et al New Zealand 2014
Evidence of use of PIG
There is good evidence that use of the GSF PIG improves early recognition or identification of patients considered to be in their last year of life.
However, this is only the first key step in the GSF Quality Improvement Programme used in different settings (primary care, care homes, hospitals, domiciliary care, prisons hospices etc.).
Intrinsic comparative evaluations of teams progressing with the GSF programme demonstrates significant change towards current population-based estimates (e.g., 1%, 30%, 80%), and that high levels of early identification in line with this can be achieved.
The further steps of GSF, including use of Needs-support matrix, MDT discussions, ongoing assessment and proactive planning, all then work together to ensure better care for patients in line with their preferences.
Evidence from GSF Evaluation Audits from each team
Early identification is GSF’s first key step. The GSF training and coaching enables staff to increase their identification rate over time, supported by use of the GSF Proactive identification guidance and abbreviated forms of it (e.g., Mini-PIG, PIGLET) through teaching, coaching, use of run-charts, workshop feedback, peer-support, etc. Over the course of a GSF Programme (6-24 months dependant on organisation and delivery), teams are able to demonstrate improvements in care at;
The data is captured before and after the delivery of the programme and at accreditation to demonstrate sustainability.
Acute Hospital Wards
Cumulated data from 10 GSF Accredited Hospital wards
Fig 1. Identification rate in GSF Accredited acute hospitals for patients in the last year of life. 2015-17 The snapshot average 34% of all patients (in line with Clarke study 2014, confirming that 29% of patients in hospital are in their last year of life).
Community Hospital wards
Fig 2. Demonstrates what is achievable in community hospital wards. The wards are from the last two rounds of GSF accreditation.
The identification rates range on average from 31% to 100%. The weekly identification range across the 8 hospitals ranged from 23% to 100.
Cumulated data from 17 GSF Accredited GP Practices (more details available).
Conclusion for these GSF GP Practices – an average identification rate of 60% of all patients (in line with population figures of estimate 1% population dying/year)
Fig 3. Identification rates ion Primary Care in 17 GSF Accredited GP practices.
Fig 3. Demonstrates that some GP practices, following GSF Going for Gold training and Accreditation, are attaining high rates of identification of patients for their GSF/Palliative Care Register, averaging 60%. This demonstrates what is possible to achieve by some GP practices, which could be an encouragement to others.
For Care Homes
For Care Homes consideration of early identification is different: all residents are considered to be approaching the end of their life and coded appropriately, with many considered to have years to live (blue code) and about 80% considered to be in their last year of life.
The Needs Based Coding relates to the predicted stage of decline. An assessment at accreditation is made of the allocated coding for people when they die (red/amber) through the After Death Analysis and most care homes are found to estimate decline appropriately. See Summary of Evidence Care Homes for more details.
Accredited GSF Hospitals
Earlier identification of patients considered to be in the last year of life is a recognised pre-cursor to improved end of life care.
22 Acute and Community Hospital wards that were GSF Accredited and received the GSF Quality Hallmark Award supported by the British Geriatric Society and Community Hospitals association in 2014-5 demonstrated high levels of early identification of patients (average over 30% patients acute hospitals and 45% community).
They also demonstrated high levels of patients offered advance care planning discussions to each identified patient (75%-100%).
This lead to an improved systematic approach to care for patients in the last year of life with any diagnosis.
Source: Ref Thomas K, Armstrong Wilson J, National GSF Centre in End of life care GSF Accreditation
flyers EAPC May 2015 Accepted Abstract http://tinyurl.com/hz7qeob
“We believe that the GSF has developed within the hospital a greater awareness for the need to have conversations about death and dying in order to plan end of life care. By raising awareness this has enabled clinicians to gain confidence in identifying patients earlier in their disease trajectory and helped to prompt effective end of life communication where needed.”
HW Wright, Palliative Care Team Leader, Barking Havering and Redbridge Hospitals
"Prior to doing the GSF Going for Gold programme, we had 27 patients on the GSF register, almost all of whom were cancer patients. Now we have 236 on the register, 70% of whom are non-cancer."
Ilkley Moor Medical Practice
“When the practice started GSF there were only 13 patients on the register. There are now 51 and the proportion of non-cancer patients has risen from 25% to 53%.
The biggest benefit of doing GSF has been the continuity of care. Whereas in the past we would tend to hand over responsibility to the district nursing team, now a named GP and the nursing team at the practice is involved throughout and the patients feel much better cared for. Now the DNs enter our team not the other way round.”
LB Practice Nurse at Grosvenor Medical Centre, HMP Norwich
Having increased the number of patients on the register from 6 to 84.
“We only have one chance to get it right. With an ageing population, this is becoming an increasingly important part of our work as GPs and so we have to ensure consistency and equality"
Dr IL, Saltaire Medical Practice.
“GSF has helped us do everything that little bit better. We are certainly better at identifying people approaching the end of life because we now look more closely and have a mental checklist. It’s also helped us to be better planned and more organised – things really flow now. It’s really helped the team feel justifiably confident in the care they are providing. Having their work acknowledged means they can boast about it.”
Acute Hospital Lead Nurse, Airedale General Hospital