An analysis of “Advance care planning” and documentation of frailty for discharged patients from an acute geriatric ward
Abstract
Introduction:
Advance care plans (ACPs) powerful tools that outline an individual’s health preferences to aid healthcare professionals when considering treatment options for individuals who are at risk of losing capacity to make decisions. This quality improvement project was conducted to analyse the documentation of frailty, and advance care planning among patients discharged to a care facility from a geriatric ward; with one year follow up on patient outcomes.
Method:
We conducted a retrospective study using discharge summaries, for patients discharged to a care facility from a geriatric ward in a district general hospital in West Wales. We assessed the accuracy of frailty and ACP decisions documentation. Additional analysis was conducted on the relationship between ACPs and further healthcare contact and one-yearly outcomes.
Results:
Of the total 57 patients 37, (65%), were recorded as clinically frail, with 35,(61%) documented with a numerical CFS. The Median CFS scores across each cycle were 6,7,7,7. Advanced Care Plans (ACP) were recorded for 13 (23%) of patients meaning 28, (76%) of patients recorded as frail did not have an ACP. At one year of follow-up, 23,(40%) of patients had died, 6 of whom (26%) had an ACP in place. Within 1 year of follow up, across the 4 cycles respectively 60%, 50%, 43% and 21% of patients were readmitted to hospital.
Conclusions:
There was a good level of documentation of clinical frailty for patients (65%) being discharged to a care facility, with the majority including a verified clinical frailty score, yet for most, there was no advance care plan in place. This represents a missed opportunity to recognise frailty and engage in proactive discussions about future care decisions. There are practical and clinical challenges in initiating ACPs during inpatient admissions. Better education and signposting to existing resources is required.
Our analysis shows the scope of potential benefits to having honest conversations during inpatient admissions on geriatric wards and documenting future care planning for clinically frail patients.