The UK Needs Rounds study is funded by the National Institute of Health Research (NIHR). It aims to improve the lives and deaths of care home residents by creating a UK model of Needs Rounds.
The research team, led by Prof Liz Forbat at University of Stirling, worked with 6 hospices and 29 care homes across England and Scotland. In July 2021, the sites started implementation of the three components of the intervention:
- Monthly clinical meetings with a hospice nurse and care home staff, to discuss residents who they would not be surprised if they died in the next year. These meetings offer a chance to talk through physical and psychological symptoms, medications, and advance care plans. The hospice staff also weave in some education based around the residents that care homes are worried about.
- Clinical work with residents: after discussing residents in a Needs Rounds clinical meeting, the hospice nurse can conduct clinical assessments with the resident to help inform decisions about care.
- Supporting family meeting (with care home staff and relatives) to discuss care, or multidisciplinary team meetings with other health/social care professionals.
Study timeline
The study was split into two phases: in phase 1, we collected information to help us create a UK model of Needs Rounds and in phase 2 we introduced Needs Rounds.
Phase 1: data collection and designing the UK model of Needs Rounds
- Interviews conducted between February – April 2021 with care home staff, relatives, palliative care specialists, and other health care practitioners supporting palliative and end of life care;
- Workshops to co-design and refine a UK model of Needs Rounds were held in April and June 2021, and May 2022. The model was developed in partnership with care homes, hospices, and our patient and public involvement and engagement representatives.
Phase 2: implementation and evaluation
Needs Rounds were implemented in 29 care homes for up to 12 months between July 2021 and June 2022.
Interventions routinely fail to change practice so we are using an implementation science approach to try and address this. We want to understand what elements of Needs Rounds work, for whom, in what circumstances and why, in the English and Scottish context.
Evaluation was based on the following methods:
- Interviews were conducted at months 4, 8, and 12 of implementation;
- Questionnaires with staff and family members to measure staff capability, quality of death/dying, and family perceptions of care;
- An economic evaluation to understand the costs and benefits of Needs Rounds;
- Recordings of Needs Rounds to assess if they are being used in the way intended;
- Analysis of resident data on health service use and hospitalisations;
- An evaluation of Patient and Public Involvement to identify successes and challenges to inform future learning.
This study has now been completed. Check the ‘Findings‘ tab to see the results, and check out our materials to use in your service.
