Background The incidence of, admission rates and mortality from COPD in the northwest are amongst the highest in the UK.¹ The Gold Standard Framework (GSF) helps to identify dying patients to facilitate early referral to palliative care, advance care planning (ACP) and an MDT approach. Data shows this increases the number of patients achieving their preferred place of death (PPD).² This project is designed to increase identification of deteriorating COPD patients to enable ACP discussions and complete EPaCCS records viewable across healthcare providers.

Methods Inpatients with COPD approaching the last year of life were identified and referred to the weekly MDT between June 2022 and May 2023. GSF criteria were discussed, and if met, a plan was made for ACP. Cases were revisited weekly until EPaCCS record completed. Additional outcomes: PPD achieved, admissions rates pre/post ACP, ReSPECT form completion, hospital/community palliative care referral.

Results 21/25 referred patients who met GSF criteria had ACP documented on EPaCCS (4/25 incomplete due to unavoidable circumstances). 9 patients have died since starting the work. PPD was met for 5/9 (4/9 had good reason why PPD was not achieved).

Average admissions in the last 12 months of life were reduced in the review group (0.39/month) compared to usual practice (0.42/month). Following ACP conversations, admissions reduced from (0.42/month) to (0.31/month). Records were most accessed by the ambulance service. Of 8 records accessed 5 admissions were avoided. Assessments for referral to palliative care were higher (9/9) than previous practice (6/9). 7/7 patients discharged home were referred to specialist services. All reviewed patients had a ReSPECT form which is an improvement on previous practice.

Conclusion The MDT shows positive outcomes, meriting research. The data will help with workforce planning and funding requirements. This data signals reduced admissions following MDT and ACP/EPaCCS implementation.

References

1. England, Public Health. The 2nd Atlas of Variation in risk factors and healthcare for Respiratory disease in England 2019. 2019. 17th October 2023. <http://tools.england.nhs.uk/images/RespiratoryAtlas/atlas.html>.

2. Sharada Gudur, Fiona O’Brien, Ahmed Salem, Imran Hasan, Nazra Hussain, Cath Corcoran, Sarah Emery, Zoe Walker-Frost, Andrew Fletcher, Paul Marsden. ‘Using Gold Standard Framework Criteria in COPD: Empowering Patients to make Choices about End of Life Care.’ European Respiratory Journal 2017;50:61. 17th October 2023. <https://erj.ersjournals.com/content/50/suppl_61/PA4968>.