Background We are aware that the number of care home residents dying in hospital in our local area is higher than average. We conducted a mortality review focusing on this population to identify areas for improvement. Particular attention was paid to understanding the number of hospital admissions in last 90 days of life, impact of advance care planning (ACP) and barriers to achieving preferred place of death (PPD).

Methods A retrospective review of care home residents who died in hospital over a 3 month period starting on 13.09.18 was undertaken. These patients were known to the hospital palliative care team. Data was collected from the palliative care referral list, electronic patient records and further discussion in MDT.

Results 34 care home residents were admitted and died in hospital. A larger proportion of patients (56%) were admitted from residential homes compared to nursing homes (38%). The vast majority of these patients had a non-cancer diagnosis (91%). 59% patients had previous emergency admissions in the last 90 days of life and were discharged. 34% of these were discharged from A&E.

Despite 41% of patients having a DNACPR in place prior to admission, only 29% had EPaCCs record created, and only 15% of patients had a clear PPD documented. Multiple barriers to achieving PPD were highlighted. Results suggested that the most significant were that care homes were unable to meet patients‘ needs (36%), rapid deterioration during admission (35%) and missed opportunities for ACP (21%). 32% of these patients changed PPD to hospital, as they were happy with care received.

Conclusions Lack of ACP and communication has been improved with a dedicated palliative care section on hospital discharge letters. Education tailored to acute areas of the trust (A&E and MAU) is being provided, and increased integrated working in these areas is being explored.