Background: Advance Care Planning (ACP) using PEACE documentation combines recommendations on clinical management planning with records of mental capacity and resident preferences. Pilot studies identified potential to reduce inappropriate readmissions and to raise community awareness of ACP (Hayes N et al 2011; Kalsi T et al 2011).
Innovation: PEACE is used on our Health and Ageing Unit (HAU) for patients transferred to nursing homes. Patients judged to be on a palliative trajectory are prioritised. This study compared outcomes for patients discharged with or without PEACE. It also sought to refine selection criteria.
Evaluation: From 11.2011 to 02.2012, 24 patients were discharged with PEACE and 39 without (controls). 6 month mortality was 21 (87.5%) for PEACE, vs 10(25.6%) controls (p < 0.01). 19 (90.4%) PEACE patients died in care homes according to their wishes vs 6 (60%) controls (p = 0.067) 6 month readmission was 22 (56.4%) for controls vs 4 (16.7%) PEACE.
Of controls, 8 (20.5%) were retrospectively judged by 2 independent reviewers to be on a palliative trajectory. PEACE was not offered to 4 of these, and was refused by 4 patients. 62.5% were readmitted within 6 months.
Conclusions: When PEACE is used for patients judged to be on a palliative trajectory, readmissions are significantly reduced and patients are more likely to die at their nursing home than patients discharged without PEACE. For longer survivors, further development of community ACP is indicated in order to promote end of life care in the right place.
We recommend that all patients discharged to care homes are assessed for palliative trajectory and offered PEACE.