51RECOGNITION OF HOSPITALISED PATIENTS LIKELY TO DIE WITHIN 30 DAYS OF HOSPITAL DISCHARGE - ARE WE MISSING OPPORTUNITIES TO COMMUNICATE END OF LIFE AND ADVANCE CARE PLANNING DECISIONS TO PRIMARY CARE?

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Abstract

Introduction: The Gold Standards Framework (GSF) has been shown to be effective in improving care for people nearing the end of life. The GSF Prognostic Indicator Guidance (PIG) helps target adult patients predicted to be in the final 6-12 months of life who might be in need of palliative care and advanced care planning.

Methods: 59 casenotes were randomly reviewed to establish how often markers of decline (from the PIG) are found in patients dying within 30 days of hospital discharge, and whether the GSF best practices were applied to their hospital care. We also recorded how frequently an increase in dependency (ID) occurred prior to death.

Results:

• Mean patient age was 84 years (range 25-96), 57% were males.

• Mean Hospital Length of Stay (LOS) was 14.81 days, (median: 12.00, range: 1-84).

• Markers of decline were found in 40/59, with general performance and specific cancer related decline being most common.

• Mean discharge to death interval (DDI) was 11.5 days (range 1-28).

• ID occurred in 23.7% with a trend toward increased LOS (17.29 vs 13.64 days) although DDI was longer (15.1 vs 10.6 days).

• 91.5% of patients were discharged with increased support or to a care home.

• GSF was suggested in only 62% of discharge letters, DNACPR decisions made in 82% and end of life preferences were only discussed with the patient or proxy in 46% of cases.

Conclusions: Most patients were elderly, frail and discharged to care settings. These data suggest that even where death is not unexpected within 12 months, hospital teams are missing opportunities for advanced care planning and admission avoidance strategies. Using ID as a flag for functional decline, and formal use of the GSF PIG toolkit may help hospital teams initiate care planning discussions needed to improve high quality end of life care.

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