Going Home to Die. The Development of the Liverpool Integrated Care Pathway for the Rapid Discharge Home of the Dying Patient

It is recognised that dying at home is the preferred option by the majority of terminally ill patients and health care professionals, yet the majority of UK deaths still occur in hospital. To meet the request of dying patients and their families to be discharged home to die, a rapid discharge integrated care pathway has been established. This pathway builds upon the Liverpool integrated care pathway (LCP) for the dying, which facilitates the decision that the patient is dying, along with effective symptom control and psychological care of the patient and family. Additionally the pathway recognised the inherent problems surrounding discharging patients home of poor communication and co-ordination. Key factors that were taken into consideration in the design of the pathway. The background and development of the initiative will be discussed along with the content of the pathway, which includes symptom control and psychological care of the patient and family. The importance of establishing clear key lines of communication with the community team and the family accompanied by additional emergency backup support systems will also be highlighted. Examples will be given to illustrate the appropriate and effective use of the pathway, as well as preliminary feedback from the hospital and community teams indicating the potential benefit of this initiative to allow patients the choice to die at home