Background Identification of patients approaching the end of life and advance care planning (ACP) with them can improve patient outcomes and reduce hospital deaths. But this aspect of care often receives little attention in the hospital inpatient setting.
Aims (i) To estimate the proportion of a sample of COTE hospital inpatients that are identified, by their own team, as likely to be in the last 6–12/12 of life; (ii) To describe these patients in terms of: likelihood of death in 6–12/12 using Gold Standards Framework Prognostic Indicator Guidance (GSF PIG); clinical complexity (using the ACE27 comorbidity score); content of any advance care plans; (iii) To ascertain the number of patients from this sample who died in the subsequent 6/12.
Methods COTE Consultant led MDTs prognosticated 57 inpatients under their care during one week in March 2016, using two screening questions. All patients thought to have an at least moderate expectation of death (based on a modified Surprise Question: ‘Would you be surprised if this patient were still alive in the next 6–12/12?’) had their notes reviewed using a standardised proforma. Six months later the number of deaths was ascertained using hospital and community databases.
Results 70% patients were considered likely to be in the last 6–12/12 of life. 98% had this prognostication confirmed with GSF PIG. 68% patients had complex care needs, but few had advance care plans recorded. Over one third died within six months. The modified Surprise Question correctly identified patients who went on to die in the following six months with a sensitivity 61% and specificity 88%.
Discussion Many COTE inpatients are in the last 6–12/12 of life. One question identifies >60% with high specificity, and this is now an integral part of the weekly COTE MDT discussion, and will prompt ACP discussions with patients and families.
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