Unnecessary hospital admissions for palliative emergencies strain resources and may not meet patients’ end-of-life preferences. This study evaluates the impact of a 3-year partnership between Macmillan Cancer Support and the Scottish Ambulance Service (SAS), launched in 2022, to strengthen community-based palliative care and establish alternative referral pathways.
A retrospective comparative analysis of SAS call data linked to emergency department (ED) outcomes was conducted for 2022 and 2023. We assessed changes in key metrics: acute-care hospital admissions, ambulance conveyance rates and 7-day mortality using 2 and two-proportion z-tests. Costs were estimated using NHS data and scenario modelling of patient length of stay.
A statistically significant 5.47% reduction in hospital conveyances was observed, equating to over 1600 fewer incidents conveyed to hospital. Estimated ambulance service savings totalled £570 871, with ED-related cost reductions from £3.6 to £5.6 million. A modest increase in 7-day mortality was noted, consistent with increasing acuity of patients managed in the community.
The SAS–Macmillan collaboration demonstrates that targeted education, alternative referral pathways and integrated community care can reduce avoidable hospital admissions and improve efficiency. The initiative offers a scalable model to enhance patient-centred, community-based palliative and end-of-life care, aligned with patient preferences.