Abstract
Introduction:
The British Geriatric Society has been a forerunner in describing the potential benefits of a comprehensive geriatric assessment and advance care planning for all patients and focusing on wellbeing strategies for this vulnerable patient group.
QIP project was undertaken with the aim to look at the fast track discharges and advance care planning documentation in accordance with the EOL care strategy 2008.
Through reviews of individual cases, it is thought that advance care plans (with recognition and interventions for patients thought to be in their last year of life) would prevent some of these unnecessary attendances and re-admissions.
Method:
One PDSA cycle as completed by looking at the fast track discharges between March 2023 and March 2024 from the care of the elderly ward. The total number of patients included in the QIP were 51. Clinical information for the patients was gathered from electronic health record. The data collected was entered on a Microsoft Excel spreadsheet and Jamovi statistical spreadsheet software was used to collect the data.
Results:
Demographics and frailty level of the patient group showed the mean age group on admission was 84.96 years, with a mean frailty score of 6.1.
Percentage of a frailty score more than 5 was 72.5% (37/51). Advance care plan was clearly discussed and documented among 78.4% (40/51) of the patients, 22% did not have clear documentation or discussion.
7.8% (4/51) were readmitted within 30 days of discharge. The majority of patients, 54.9% (28/51), were discharged to a Nursing Home, with 33.3% (17/51) discharged to their own homes.
From the patient group death in hospital was 11.8% (6/51), death outside hospital was 56.9% (29/51), and 31.4% (16/51) remained alive at the time of data collection.
Of the 51 patients, 2% (1/51) were readmitted, 2% (1/51) came back into the Emergency Department (ED) but were not admitted, 4% (2/51) came back for an outpatient appointment and 80% (41/51) did not come back into hospital at all. Based on the age profile, we would expect 9% to die, 15% to readmit and 8% to return to ED without admission within 30 days.
Conclusion:
We had very good outcome in relation to re-admission with only 2% were readmitted and 80% did not come back into hospital at all. We have achieved patient centered care while clearly avoiding readmission's.
Comments
Changed the author sequence numbering
Changed the author sequence numbering as Anila Minhas1, Kumudhini Giridharan1, Maksim Richards2
Previous hospital admissions?
I was interested in your poster and that a high number of people had advance care plans. Was this on a ReSPECT plan or on a more detailed ACP?
Did you identify any differences in the group that did not have ACPs that might explain why these were not done?
Did you look at how many of the patients had been admitted to hospital in the months before the admission where they were fast tracked and if an ACP had been considered then?
Did any of the patients have a community ACP prior to this admission?
Thank you for your comment…
Thank you for your comment.
ReSPECT forms were only initiated in our Trust after the first cycle of QIP in April 2024. We have completed second cycle of PDSA on ReSPECT form to look at the readmission and LOS for our patients.
The QIP which we completed relates to more detailed ACP between the duration March 2023- March 2024.Advance care plan was clearly discussed and documented among 78.4% of the patients, 22% did not have clear documentation or discussion. The reason 22% who didn't have clear documentation regarding ACP was due to different people completing ACP and was not documented fully prior to their discharge from hospital.
None of the 51 patients we completed the ACP had any prior advance care plan or Fast Track discussion.
No clear ACP was discussed in the Community as well for the cohort of 51 patients with whom we discussed the ACP
I would like to forward the second cycle of ReSPECT we have completed if that interest you
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