Background With a rapidly ageing population and advances in medicine, hospital inpatients are increasingly frail with complex needs, and frequently die in hospital. Advance Care Planning (ACP) is a valuable process supporting clinicians to provide patients with the right care, at the right time, in the right place.
The Gold Standards Framework (GSF) is a structured approach to ACP for patients likely to be in their last year of life. In our Trust geriatric wards have been using GSF for several years, however acute medical wards have less experience of ACP, despite many of their inpatients being in their last year of life due to both malignant and non-malignant conditions.
Aims To assess the quality and quantity of ACP on a Gastroenterology ward at Queen’s Hospital, Romford before and after implementation of GSF. We also aimed to explore:
The proportion of inpatients dying within one year
Impact of ACP on length of stay, number of readmissions and place of death.
Methods Retrospective review: We identified all admissions to the ward over June 2017. All patients dying within one year were selected; data was extracted from medical notes. Data included diagnosis, length of stay, number of subsequent admissions, preferred place of care, DNAR status, and use of any formal ACP documentation.
Prospective audit: In June 2018 we implemented GSF to the ward. All patients identified were offered ACP. Comparable data was collected prospectively.
Results In June 2017, 106 patients were admitted to the ward; of these 27 have died to date. We continue to analyse these records. We are currently collecting prospective data throughout June 2018.
Conclusion Our data supports existing literature indicating that approximately 1/3 of inpatients are in their last year of life (Clark, Armstrong, Allan et al., 2014). Full results will be presented at the 2018 Hospice UK Conference.
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