Jordan Ellis
The AMBER (Assessment, Management, Best Practice, Engagement, Recovery Uncertain) care bundle is an intervention used in hospitals to support patients with uncertain recovery. The AMBER pathway is designed to improve the quality of care for patients with end-stage progressive disease and uncertain recovery by encouraging open communication between healthcare professionals, patients, and their families. It includes the development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status, and daily plan revisiting. The AMBER care bundle was developed in response to previous end-of-life care packages that were sometimes poorly implemented, leading to inconsistent care for patients with terminal illnesses and uncertain recoveries. While it has been implemented in hospitals in the UK, Australia, and New Zealand, it has not yet been evaluated in a randomised controlled trial to identify potential benefits or harms fully.
| Characteristics | Values |
|---|---|
| Full Form | Assessment, Management, Best practice, Engagement, Recovery uncertain |
| Purpose | To improve the quality of care for people whose recovery is uncertain and who may be approaching the end of their life |
| Target Group | Patients with uncertain recovery nearing the end of life |
| Implementation | Developed at Guy's and St Thomas' Hospital, implemented by a nurse facilitator |
| Features | Development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status, daily plan revisiting, open communication |
| Benefits | Shorter hospital stays, more discussions about prognosis, higher awareness of prognosis, increased communication |
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What You'll Learn
AMBER care bundle implementation
AMBER, which stands for Assessment, Management, Best practice, Engagement, and Recovery uncertain, is a care bundle designed to help hospital inpatients with uncertain recovery nearing the end of life. The AMBER care bundle was developed to address the inconsistent care received by patients admitted to the hospital with a terminal illness and uncertain recovery. These patients often do not have the opportunity to die in their preferred place of death.
The AMBER care bundle is implemented by a nurse facilitator and includes the development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status, and daily plan revisiting. The plan is designed to work alongside active medical care when uncertainty about the outcome remains. It encourages regular and open communication between staff, patients, and families about their preferences and priorities, helping them plan ahead and make informed decisions about treatment and care.
The AMBER care bundle is a complex intervention that has been used in UK hospitals to support patients with uncertain recovery. It has not been evaluated in a randomised controlled trial (RCT) to identify potential benefits or harms. A feasibility study showed that a full trial of the AMBER care bundle is technically possible but not practical due to problems with the intervention eligibility criteria. The recruitment rate was lower than anticipated, and the inclusion criteria for the trial were difficult to interpret. The intervention requires optimisation, including simplifying the inclusion criteria and improving healthcare professional communication training.
The AMBER care bundle was developed at Guy's and St Thomas' Hospital to provide better outcomes for patients and their families. It aims to improve the quality of care for people whose recovery is uncertain and who may be approaching the end of their lives. It is one of the tools mentioned in the NICE guidance on end-of-life care for adults.
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Benefits and harms
The AMBER (Assessment, Management, Best Practice, Engagement, Recovery uncertain) care bundle is a complex intervention used in hospitals to support patients with uncertain recovery. It was developed to address the inconsistent care received by patients admitted to hospital with a terminal illness and uncertain recovery. These patients often do not have the opportunity to die in their preferred place of death.
The AMBER care bundle is implemented by a nurse facilitator and includes the development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status, and daily plan revisiting. It encourages staff, patients, and families to talk openly about their preferences and priorities. It also aims to increase the frequency of communication regarding treatment plans, the preferred place of care, and other concerns.
The benefits of the AMBER care bundle include improved awareness of prognosis and more frequent discussions between clinicians and patients and carers. It also provides a systematic approach to managing the care of hospital patients with end-stage progressive disease and uncertain recovery. The AMBER care bundle has been identified as one of the key enablers in the Transform Programme to improve End-of-Life Care in acute hospitals. It is being piloted or used across 38 hospitals in England and in nine hospitals in New South Wales, Australia.
However, there are also potential harms associated with the AMBER care bundle. One study found that it did not improve patient or family-reported views of communication, and those cared for under the AMBER care bundle found the information less easy to understand. Another study found that the inclusion criteria for the trial were difficult to interpret, and the information sheets and consent procedures were too detailed and lengthy for the target population. The recruitment rate was lower than anticipated, and the intervention requires optimisation.
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Eligibility criteria
The AMBER (Assessment; Management; Best practice; Engagement; Recovery uncertain) care bundle is a complex intervention used in UK hospitals to support patients with uncertain recovery. It is implemented by a nurse facilitator and includes the development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status, and daily plan revisiting.
The eligibility criteria for the AMBER care bundle trial were difficult to interpret. Information sheets and consent procedures were too detailed and lengthy for the target population. The inclusion criteria for the trial were as follows:
- Participants must be hospital inpatients with uncertain recovery nearing the end of life.
- Over half (53.8%) of participants had a non-cancer diagnosis, with a mean of 2.3 comorbidities.
- 24.6% of patients (n=16) died during their hospital stay, and 35.4% (n=23) within 100 days of discharge.
- Participants must be willing to participate in semistructured interviews, focus groups, and non-participant observations.
- Participants must be willing to complete a bereavement standard care survey.
- Participants must be willing to have case note reviews and heat maps completed.
The recruitment rate for the trial was lower than anticipated, and the majority of participants were lost to follow-up because they had been discharged. Those who participated may have had different characteristics from those who did not. This feasibility trial demonstrated that a full trial of the AMBER care bundle is technically possible but not practical due to problems with the intervention eligibility criteria that require attention.
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Medical plan development
The AMBER (Assessment, Management, Best Practice, Engagement, Recovery uncertain) care bundle is a complex intervention used in UK hospitals to support patients with uncertain recovery. The AMBER care bundle is implemented by a nurse facilitator and includes the development and documentation of a medical plan.
The medical plan is designed to encourage health professionals to work with patients and their families to develop and document a clear plan. This includes consideration of anticipated outcomes, cardiopulmonary resuscitation, and escalation status. The plan is revisited daily and encourages regular communication with the patient and their family regarding treatment plans, place of care, and any other concerns.
The AMBER care bundle aims to improve the quality of care for people whose recovery is uncertain and who may be approaching the end of their life. It is important to talk to the healthcare team about preferences and wishes and to ensure that all staff know about the patient's condition so they can work together to provide the best care and support.
The AMBER care bundle was developed to address the inconsistent care received by patients admitted to the hospital with a terminal illness and uncertain recovery. Previous end-of-life care packages, such as the Liverpool Care Pathway for the Dying Patient, were sometimes poorly implemented, leading to poor patient outcomes. The AMBER care bundle encourages open communication between staff, patients, and their families about their preferences and priorities.
The implementation of the AMBER care bundle has been identified as one of the key enablers in the Transform Programme to improve End-of-Life Care in acute hospitals. It provides a systematic approach to managing the care of hospital patients with end-stage progressive disease and uncertain recovery from an acute deterioration in their condition.
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End-of-life care
The AMBER (Assessment, Management, Best Practice, Engagement, Recovery uncertain) care bundle is a complex intervention used in UK hospitals to support patients with uncertain recovery. It was developed to improve the quality of care for people whose recovery is uncertain and who may be approaching the end of their life. Patients admitted to hospital with a terminal illness and uncertain recovery often receive inconsistent care and do not have the opportunity to die in their preferred place of death.
The AMBER care bundle is implemented by a nurse facilitator. It includes the development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status, and a daily plan revisiting. The bundle was designed to work alongside active medical care when uncertainty about the outcome remains. It encourages staff, patients, and families to talk openly about their preferences and priorities. It also aims to increase the frequency of communication regarding treatment plans, the preferred place of care, and other concerns.
The AMBER care bundle was developed to remedy the issues with previous end-of-life care packages, such as the Liverpool Care Pathway for the Dying Patient, which was previously used across England. An independent review identified that it was often not used appropriately, leading to poor patient outcomes. The AMBER care bundle was designed to provide better outcomes for patients and their families.
The AMBER care bundle is a systematic approach to managing the care of hospital patients with end-stage progressive disease and uncertain recovery from an acute deterioration in their condition. It has been identified as one of the key enablers in the Transform Programme to improve End-of-Life Care in acute hospitals. It is important to note that the AMBER care bundle has not yet been evaluated in a randomised controlled trial (RCT) to identify potential benefits or harms. However, it is currently being piloted or used across multiple hospitals in England and Australia.
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Frequently asked questions
AMBER, which stands for Assessment, Management, Best practice, Engagement, and Recovery uncertain, is a care bundle used in hospitals to support patients with uncertain recovery.
The AMBER care bundle is implemented by a nurse facilitator and includes the development and documentation of a medical plan, consideration of outcomes, resuscitation and escalation status, and a daily plan revisiting.
The AMBER care bundle aims to improve the quality of care for people whose recovery is uncertain and who may be approaching the end of their life. It also aims to increase the frequency of communication between patients, their families, and healthcare providers.
The AMBER care bundle encourages staff, patients, and families to talk openly about their preferences and priorities regarding treatment plans, place of care, and any other concerns. It is designed to work alongside active medical care when uncertainty about the outcome remains.
The AMBER care bundle was developed at Guy's and St Thomas' Hospital in the UK. It has been piloted or used across 38 hospitals in England and is also being piloted in nine hospitals in New South Wales, Australia.
