Electronic Palliative Care Coordination Systems (EPaCCS) in care homes


BNSSCG CCG Research Capability Funding (Local development)

What is the research question?

Are Electronic Palliative Care Coordination Systems (EPaCCS) in care homes effective, and how can their effectiveness be improved?

What is the problem?

EPaCCS are summaries of advance care planning discussions and patients’ dying preferences, stored electronically, ideally as part of the patient’s electronic medical records. They could then be accessed and edited any time anywhere, by healthcare professionals involved in the patient’s care. When implemented, EPaCCS ensured that around 78% of patients died where they wished, a 45% lower rate of hospital admissions, and an average saving of £2100 per person who dies with an advance care plan, through reductions in hospital attendance and length of stay aligned with patient wishes. However, the system relies on GPs to update the forms and upload them onto the patient’s records. Care home staff and community hospice staff who are familiar with the patient’s changing needs and wishes, tend to write to the GP, who then, workload-permitting, would update the patient’s EPaCCS accordingly. This, however, is time consuming, does not facilitate decision changes and may not be done promptly. A BNSSG project is underway to implement EPaCCS in 65 care homes in the area, using the Connecting Care platform, and at the same time as the ReSPECT project (Recommended Summary Plan for Urgent Care and Treatment) which may complicate implementation.

What is the aim of the research?

The study aims to assess the effectiveness of Electronic Palliative Care Coordination Systems (EPaCCS) in care homes and identify potential solutions to enhance their effectiveness. This research aims to outline the mechanisms that could accelerate communication between GPs and care homes, and the systems that could be set up to ensure patients’ wishes are communicated and recorded in a timely manner. The study will assess if EPaCCS:

  • Improves coordination and communication between professionals, patients and carers/family about end of life care.
  • Ensures patients die in the place they have chosen.
  • Reduces unnecessary ambulance call outs, ED attendances and hospital admissions.

How will this be achieved?

First, a realist review of EPaCCS studies will be conducted to explain the circumstances in which EPaCCS worked (or not) to deliver their intended outcomes. We will then develop the initial programme theories based on the realist review, interviews and surveys (with care home staff, care home residents, GPs, PCN pharmacists, the BNSSG EPaCCS project team and organisations accessing EPaCCS through Connecting Care), data on local hospital admissions from care homes, ambulance call outs and death in usual place of residence, observations of end of life care in care homes and GP ward rounds, policy documents and EPaCCS protocols.

Who is leading the research?

Dr Ilhem Berrou and Catherine Piggin, Senior Lecturers, Nursing and Midwifery, Centre for Health and Clinical Research, University of the West of England.

Further information

About Ilhem Berrou
About Catherine Piggin

For more information or to get involved with this project, please contact bnssg.research@nhs.net.