1012 ASSESSING THE CLINICAL EFFECTIVENESS OF EMERGENCY HEALTH CARE PLANS (EHCPS); A RETROSPECTIVE REVIEW

Abstract

Abstract Introduction Almost 30% of hospital patients are in their last year of life; mortality is five times higher one year post-hospital admission for patients aged 85+ (Clark D, Armstrong M. Palliative Medicine, 2014, 28, 474–479). Studies have shown 40–50% of those who die in hospital could have died in the community (End of Life Care, National Audit Office, 2008). As a geriatric department, we wanted to adopt existing good practice to ensure we were recognising individuals in their last 12 months of life and enabling them to die where they chose. Method Using the Gold Standards Framework (Clifford C, Thomas K, Armstrong-Wilson J. End of Life, 2016, 6) in 2019 DrZin introduced a standardised document for EHCPs. We reviewed 123 EHCPs implemented March 2019—August 2021, focusing on the number of attendances to A&E in the year prior to implementation, the number of avoidable admissions to hospital following completion of an EHCP, and place of death. Results Of 123 patients, the mean number of A&E attendances in the year before EHCP implementation was 2.52 per patient; post implementation it was 0.18. There were 22 A&E attendances after implementation (17.8%); all resulted in an admission. Of those, 12 (54.5%) were deemed avoidable. There were 100 deaths (81.3%) within 12 months of implementation; 5% died in hospital. Conclusion 95% of patients with an EHCP died in their preferred setting. Having an EHCP reduced patients’ attendance to A&E. However, work is required to reduce avoidable attendances, through education for GPs and community carers. Although every EHCP was sent to the patient’s GP and residence, several attendances contained no reference to the patient having an EHCP. Therefore, the next step of our project will be creating an alert for patients with an EHCP on their electronic record and re-reviewing hospital admissions rates.