Welcome to Respiratory Futures Dr Alison Boland, could you tell us about the staff that make up your team?
I am a Respiratory Consultant at Leeds Teaching Hospitals Trust Working as a specialist in the ILD and COPD services. I have a specialist interest in end stage lung disease and am lead for the Leeds Integrated Palliative COPD MDT.
The leads for the different areas of our team are:
- Dr Suzie Gillon (Palliative Care Consultant - Leeds Teaching Hospitals Trust)
- Ms Anne Wilkinson (Respiratory Nurse Specialist - Clinical Lead, Community Respiratory Team, Leeds Community Health Care Trust)
- Dr Jason Ward (Palliative Care Consultant - St. Gemma’s Hospice, Leeds)
- Dr Chris Kane (Palliative Care Consultant - Wheatfields Hospice, Leeds)
- Dr Chris Hosker (Consultant Psychiatrist - Leeds and York Healthcare Partnership Trust)
- Dr Stanely Miller (Respiratory Consultant - Clinical lead for Integrated COPD Service, Leeds teaching Hospitals Trust)
This diverse group of people means that at the MDT we have representation from:
- Respiratory: Consultants, nurses and physiotherapist working in community and hospital.
- Palliative Care: Consultant or Nurse from both city hospices and hospital teams.
- Liaison Psychiatry: Consultant
Fantastic, and could you give us some background to the service please?
The Leeds Integrated Palliative COPD MDT is a new initiative which is part of the established, Leeds Integrated COPD service.
Approximately 3,000 people in Leeds are living with severe COPD. These people have a significant symptom burden resulting in multiple hospital attendances and unplanned health care usage. In 2017 there were 1,672 admissions in Leeds with an exacerbation of COPD, 95 patients had 3 or more admissions within a year and 463 patients were readmitted within 30 days of discharge.
We established a pilot integrated palliative COPD MDT in April 2018 with the aim of improving the accessibility of palliative and end of life care for people with severe COPD with the aim of reducing unplanned healthcare utilisation.
Of the first 24 people with COPD analysed, total admissions decreased by 47% in the 6 months subsequent to their first MDT discussion. Total bed days also showed a marked fall by 42%. People who died were excluded from the analysis.
The monthly MDT runs monthly in partnership with palliative care and psychiatry. A list of patients with a readmission within 30 days of discharge with an exacerbation of COPD is generated from the Trust’s readmissions data. This list is reviewed by me identifying patients with markers of severity who would benefit from a discussion at the MDT. Those patients not requiring discussion are flagged up to the integrated COPD service for clinical review in view of their recurrent admissions. Patients can also be referred to the MDT from any members of the MDT or their colleagues.
The Integrated Palliative COPD MDT is accessible to primary care in Leeds through the integrated COPD service single point of referral as well as directly contacting any member of the palliative COPD MDT. Referrals from secondary care are usually direct to members of the MDT.
What do you feel have been the main successes for the team?
Over a 10 month period, 76 people with COPD, 65 of which were first time discussions, have been discussed at the MDT. 53% of individuals were identified from recurrent admissions lists and as such would have been expected to have most contact with relevant services already. Our data shows 55 (73%) patients had a change in management plan that was directly attributable to the MDT discussion meaning that care was being optimised even in the most vulnerable group of people with severe COPD.
staff surveyed feel the MDT has positively impacted on patient care, predominantly through: joined up care; less duplication of work; peer learning; common goals of treatment; better working relationships across the city and greater awareness of services available.
If patients are being regularly admitted they may never be well enough to come to clinic and miss the opportunity to optimise their medical treatment. 36 patients were actively offered a new appointment with a respiratory consultant or respiratory nurse as a result of MDT discussion ensuring they received the specialist input they needed.
The MDT also identified 19 people with COPD that would benefit from specialist palliative medicine review.
We identified 20 patients that would benefit from hospice services, including allied health professional support, giving them access to further support and tailored breathlessness management programmes.
Advance care planning is a key part of helping individuals receive the care they want and also preventing unnecessary admissions. The MDT identified 16 people where further discussions were felt to be needed about their future care needs and these were arranged as a result.
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.
As well as addressing unmet needs of individuals, preliminary analysis shows encouraging trends in terms of healthcare utilisation:
Of the first 24 people with COPD analysed, total admissions decreased by 47% in the 6 months subsequent to their first MDT discussion (130 before 69 after). Total bed days also showed a marked fall by 42%, from 1104 in the 6 months prior to discussion, vs 646 in the subsequent 6 months. People who died were excluded from the analysis.
Staff satisfaction with the MDT process has been high and a recent evaluation found all staff surveyed feel the MDT has positively impacted on patient care, predominantly through: joined up care; less duplication of work; peer learning; common goals of treatment; better working relationships across the city and greater awareness of services available.
Although initially set up for COPD patients we hope to expand this service to include all respiratory patients with end stage lung disease.
This has been an extremely beneficial service for patients as well as staff involved. As well as providing better patient care (as demonstrated by the outcome measures) it has also greatly improved collaboration between palliative care and respiratory.
Thanks for talking to us Alison, and good luck with the expansion of the service - keep us posted!