Background The End of Life Care Strategy (2008) highlighted the need to raise the quality of care provided to dying people in care homes and this is supported by The Route to Success in End of Life Care – Achieving Quality in Care Homes. (2010) Previous work done locally had suggested there were a large number of attendances at Accident and Emergency (A+E) by care home residents and in order to understand whether any of these were avoidable and form conclusions as to how support for staff caring for these patients could be improved, a greater understanding of what happened at the care home prior to transfer to hospital was felt to be needed.

Aim To conduct a prospective audit of all A+E and Emergency Admission Unit (EAU) attendances by care home patients at the end of life.

Methodology Care home patients presenting to A+E and EAU were identified on a daily basis over a 2 month period. Baseline data was collected from the time of arrival to A+E or MAU. Telephone consultations then took place with the care homes in question to obtain information about what happened to the patient leading to the resultant transfer to hospital.

Results Results demonstrated the extent of coordinated care, review by community clinicians prior to transfer and also the use of end of life tools such as the GSF.

Conclusion Service improvement initiatives have been targeted to reduce hospitalisation by admission avoidance, further develop the use of end of life tools in care homes, increase the confidence and expertise of care home staff, with the ultimate aim of improving the experience, co-ordination and quality of care that care home residents receive at the end of life.