Abstract
Introduction
Advance Care Planning (ACP) should be discussed with patients in the last 12-months of life. Clinical frailty scale (CFS) ≥7 correlates with a 1-year mortality of ≥50%. Optional Electronic Patient Record (EPR) ACP documentation was introduced in 2020, enabling routine data collection on ACP which showed an increase in ACP conversations documented over time. We aimed to establish if this was representative of the number of ACP conversations happening, applying the findings to configuration of a new EPR planned for October 2024.
Methods
Retrospective paper notes review of 38 patients discharged between Dec 2022 - March 2023 with admission CFS 8-9 or with new NHS continuing health care fast-track funding (fast-track) (19 from each group). We assessed whether ACP was considered, discussed, and documented at discharge. An admission narrative was included to assess themes / barriers to ACP conversations.
Results
Routine EPR data for the 4-month period indicated ACP for 51% of the fast-track group and 23% of the CFS group. However, from notes review 95% (18/19) of the fast-track group had ACP conversations, 79% (15/19) documented at discharge; 58% (11/19) for the high CFS group. For fast-track patients, 58% (11/19) were on EPR, 21% (4/19) on discharge summaries; for the CFS group 37% (7/19) were on EPR and 21% (4/19) on discharge summaries.
Conclusions
Routinely collected data from the EPR underestimated the number of ACP conversations occurring. Documentation on the electronic template was more detailed compared to discharge summaries. Whilst the project was limited by a delay in new EPR implementation to July 2025, the lessons learned are still applicable. Automatic coding of ACP will facilitate data collection irrespective of how ACP is documented. Coding of recorded CFS offers the opportunity for auto-prompts to consider ACP. This should improve our data capture and facilitate further quality improvement work.