P260 Improving end of life care for people with COPD; outcomes of a newly established integrated palliative COPD MDT

Introduction Individuals with severe COPD have a significant symptom burden resulting in multiple hospital attendances and health care usage. With the aim of improving the accessibility of end of life care for these patients, and as a consequence reducing hospital attendance, we established an integrated palliative COPD MDT. Methods The hour-long monthly MDT has representation from, respiratory medicine both primary and secondary care based, hospital palliative care team, two hospices and psychiatry. A list of patients with frequent COPD related admissions is generated from the hospital readmissions data and reviewed by a respiratory consultant identifying patients with markers of severity who would benefit from a discussion. Patients referred by any members of the MDT are also discussed. Data on actions following MDT and new referrals generated was collected. The total number of admissions and bed days in the 6 months before and after the first discussion at the MDT was also analysed. Patients who died during this time period were excluded. Results In the first 9 months, 69 discussions took place about 55 unique patients. Meantime of the first discussion to death was 94 days (13.4 weeks) 39 patients had a full 6-month pre and post dataset. (Table 1) 55 (73%) patients had a change in their management plan, with new referrals generated to; Respiratory specialist 36; Palliative Medicine 19; Hospice services (including day hospice, breathlessness management programmes etc) 20. The symptoms of COPD can be made worse by concurrent conditions such as anxiety or depression. The presence of a liaison psychiatrist, towards the end of the pilot period, allowed discussion of 9 patients where this was most complex to ensure that their mental health needs were also being addressed. Conclusion This short monthly MDT has demonstrated the positive benefits of integrated working across organisational boundaries for a vulnerable group of patients with COPD. We have demonstrated a reduction in acute healthcare usage, therefore, enabling patients to spend more time out of the hospital. Outcomes are thought to be due to: shared expertise; ensuring care is optimised and not duplicated, and enabling patients to access all services available to them.