Background Early identification of patients in their last year of life is a national focus, enabling the expression of preferences through Advance Care Planning (ACP). This is particularly relevant to patients in nursing homes, who die on average within 18 months of admission. This service evaluation aimed to establish if ACPs are followed appropriately by care homes and hospital staff.
Methods Retrospective data collection was undertaken for patients aged >75 admitted to the Emergency Department over a 6-week period (January-February 2019). A total of 120 patients from care homes were included. Review of the Co-ordinate My Care (CMC) database identified which patients had existing ACPs.
Results 17% of patients had a CMC record on admission. 26% had one created subsequently, and 57% had no CMC record. The most common recorded diagnoses were Dementia (45%) and Frailty (25%). 30% of patients were ‘For treatment of reversible conditions in the home/hospice setting’. Hospital admissions for these patients should theoretically be avoided, but in 83% of cases there was no acknowledgement of their CMC record. For patients who had a CMC record created during or post admission, 61% were identified as not for readmission. This group had the highest proportion of subsequent deaths (26%) and lowest number of subsequent admissions (0.4 per patient).
Conclusion Less than 20% of patients from care homes had a pre-existing CMC record, despite being a group to target for ACP. 30% of admissions were inappropriate and 16% of patients with newly created CMC records had subsequent inappropriate admissions (including two inpatient deaths). Further work is required to identify the challenges to managing patients within the community and factors contributing to hospital admission. Finally, when patients had a pre-existing CMC record there was poor recognition of this. Improved awareness is necessary to ensure that ACPs are reviewed appropriately.
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