Background Advanced care planning (ACP) and end of life discussions commonly happen in hospital. However, on discharge into the community there is often a poor handover from the hospital team regarding these decisions. Improving this communication is essential to reduce inappropriate admissions and ensure patient preferences are respected and needs appropriately met by community teams and on readmission to hospital.
Aim We aimed to improve the communication of ACP made in hospital by introducing an electronic ACP record on the discharge summary.
Method Retrospective baseline data was collected between November – December 2018 on an elderly care ward. This included whether ACP happened during hospital, who was this had with, whether they have a ‘do not attempt resuscitation’ (DNAR) form and would the multidisciplinary team (MDT) be surprised if the patient died within the next 12 months.A mandatory tick-box was then added to the electronic discharge summary asking whether ACP decisions had been made or not. Further data from the same ward was then retrospectively collected between November– December 2019.
Results In total 71% (n=43) of patients were felt by the MDT that they would not be surprised if they died within the year. 72% (n=43) of patients had a DNAR form. The baseline data (n=23), showed that of those patients with DNAR forms only 29% of discharge letters communicated this decision. The post intervention data (n=20), showed of those with DNAR forms 50% were communicated on the discharge summary.
Conclusions This simple intervention has improved the communication between secondary and primary care teams. However further improvements are needed, the regular changeover of junior doctors means there is variability in how well the ACP is filled in. Further education regarding the importance of clear communication is needed and would be helpful at induction for new doctors.
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