Introduction Identification of patients approaching end of life, and advance care planning (ACP) with them, can improve patient outcomes and reduce hospital deaths.
Methods The essential items that should be included in any initial ACP discussions were agreed by a working group (COTE doctor, palliative care doctor and nurse, GP and Patient in Partnership Group). Some items were mandatory and some dynamic. Items included:
Dropdown menu: prognostication (based on SPICT)
Yes/No: elements of discussions had, e.g. regarding prognostication, resuscitation status during stay, Preferred Place of Care, Preferred Place of Death
Free text: e.g. ceilings of care.
These items were added to the usual hospital discharge summary template (EPRO) by the Trust’s IT department. Patients were identified as appropriate for invitation to ACP discussion by using a modified Surprise Question (found to have 61% sensitivity and 88% specificity in this group), which was used as standard during COTE MDT discussions. Following a short training session to COTE team, at discharge the modified discharge summary was used for appropriate patients.
COTE discharge summaries were surveyed using a standardised proforma to quantify recording of ACP preferences (n=40 at baseline and n=20 10 weeks after new template introduced).
Results The new ACP template improves frequency of documentation in discharge summaries from baseline of: resuscitation status (10% to 100%) information regarding prognostication (0% to 100%) and any mention of patient preferences for care (8%–100%).
Conclusion Specific items added to the hospital discharge summary at no extra cost improves ACP information sharing from secondary to primary care. Staff fed back that the ACP discharge summary fields were easy to use. The teams continue to engage with the process as they see improved cross boundary communication, and it is useful upon any readmission as discharge summaries are more readily accessed than the paper notes.
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