Improving patient reported experience in inpatients with palliative care needs: a pre-post quality improvement study

BACKGROUND: Optimising hospital care to align with what matters most for people living with advanced serious illness is a global priority area for improvement. Collection and feedback of patient reported experience measures (PREMs) is one potential method to inform improvements. This study used the integrated Promoting Action on Research implementation in Health Services (i-PARIHS) framework to inform the implementation of a complex intervention that included collection and feedback of PREM data and facilitation to empower ward-based quality improvements for inpatients with advanced serious illness. METHODS: A single-site pre-post quality improvement study within a large Australian hospital. The intervention titled Listen, Empower and Act to improve Hospital Palliative care (‘LEAHP’ bundle) included three phases: ‘Listen’ – collecting and analysing patient (PREM) and clinician perspectives to understand current care experience and local context; ‘Empower’ – collating PREM feedback and facilitating local stakeholder engagement to identify and prioritise areas for improvement; and ‘Act’ – facilitating clinician led innovation development and implementation informed and monitored by continuing PREM collection and feedback. Intervention fidelity was summarised descriptively from field notes and meeting records. The primary effectiveness outcome was change in ‘very good’ experiences over time, reported from an eight-question validated PREM designed for inpatients with serious illness (consideRATE). Analysis used mixed binary logistic regression with time period as fixed effect and ward as random effect. RESULTS: The three participating wards completed the intervention with some adaptations, and each implemented different innovations. The proportion of ‘very good’ responses showed a statistically significant increase for all consideRATE questions in intervention periods 1–4 compared to period 0 (baseline). All questions except ‘attention to feelings’ (Q2) were significantly improved by the first measurement period, and all except ‘attention to affairs’ (Q6) remained significantly higher than baseline during the final measurement period. CONCLUSIONS: Implementation of the LEAHP bundle led to improved palliative care experience within three wards in one large tertiary hospital setting. Listening to patients and empowering clinical teams to collectively reflect on data and lead change was crucial to study success and required skilled facilitation. Testing the sustainability, transferability and scalability of the intervention will be important next steps.