PPF54 Analysing the impact of medical domiciliary visits for community palliative care patients: a service evaluation review conducted in the North West

<h3>Background</h3> The NHS Long Term Plan prioritises moving care into the community to reduce pressure on hospitals. Palliative care virtual wards and domiciliary visits (DVs) are increasingly used to support patients who might otherwise require hospital or hospice admission. Evidence shows that home-based palliative care reduces hospital use and costs; however, limited data describe the frequency and nature of DVs for people requiring specialist palliative care at home. <h3>Aim</h3> This service evaluation examined the nature and frequency of medical DVs for people receiving specialist palliative care at home in the North West of England. <h3>Methods</h3> A retrospective review was undertaken of all medical DVs recorded from a specialist palliative care inpatient unit in the North West over a three-month period. Data were extracted from electronic healthcare records, including: 1. Multidisciplinary Team (MDT) involvement 2. Interventions (e.g. symptom management, medication review, advance care planning) 3. Outcomes (e.g. referrals, admission avoidance) <h3>Results</h3> A total of 114 DVs were completed for 79 patients, with a mean response time of 1.35 days from referral to review. Joint visits with the hospice palliative care MDT occurred in 11% of cases, and 39% involved external allied health professionals. Common interventions included symptom advice and medication review. Advance care planning was discussed in one third of visits. One in four visits resulted in referrals to hospital or community services. Hospital or hospice admission were estimated to have been avoided in 26% of visits. <h3>Conclusion</h3> Medical DVs were successfully integrated into specialist community palliative care, enabling timely holistic care at home and reducing unplanned admissions. Based on published estimates of avoided hospital days, these visits potentially saved the NHS around £125,000 over three months. Further evaluation is needed to assess the wider community impact of DVs.