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P-27 Mainstreaming initial advance care planning (ACP) discussions in 30 UK hospitals as a means of improving end of life care, using the gold standards framework hospital programmes in acute and community hospitals
  1. Keri Thomas and
  2. Wilson J Armstrong
  1. National GSF Centre for End of Life Care, West Midlands, UK

Abstract

Background A third of hospital patients are in their last year of life and still most people die in hospital. Introducing initial Advance Care Planning (ACP) discussions is particularly challenging in hospitals, but crucially important. The UK Gold Standards Framework (GSF) programmes in End-of-Life Care, widely used in the community, have been introduced to some hospital wards and could help mainstream use of ACP.

Aim To report findings from GSF Programme evaluations in over 30 hospital wards, and from the first GSF Accredited wards.

Methods The GSF Acute/Community Hopspitals training programmes provides 2–3 year service improvement training to generalist staff to enable radical transformational change in end-of-life care. Multiple methodology is used with formative and summative assessments, including.

  1. Key Outcome measures – run-charts and attainment of 10 key outcomes

  2. Comparative before and after Audits -

    1. Patient Level – After Death/Discharge Analysis x 30 per ward

    2. Organisational questionnaire

    3. Staff confidence survey

    4. Carers/relatives’ feedback.

  3. Portfolio of Evidence

  4. Assessment Visits

Results Findings included earlier identification of EOLC patients (30%), more advance care planning discussions, improved staff confidence, cross-boundary communication, reduced length of stay, enabling more to die at home. More details available.

Discussion GSF Hospital programmes supported successful implementation of initial hospital-adapted ACPs for appropriate patients through a structured framework, earlier recognition, greater staff openness and triggering better cross-boundary communication.

Conclusion GSF Hospital programmes are a means of supporting higher adoption of ACP discussions in hospitals, leading to improvements in end-of-life care.

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