Advanced Care Planning in Patients Referred to Hospital for Acute Medical Care: Results of a National Day of Care Survey

Abstract

Introduction: Advanced care planning (ACP) is a voluntary process of discussion about future care between an individual and their care provider. ACP is a key focus of national policy as a means to improve patient centered care at the end-of-life. Despite wide held belief that ACP is beneficial, uptake is sporadic with considerable variation depending on age, ethnicity, location and disease group. Methods: This study looked to establish the prevalence of ACP on initial presentation to hospital with a medical emergency within The Society of Acute Medicine Benchmarking Audit (SAMBA'18). 123 acute hospitals from across the UK collected data during a day of care survey. The presence of ACP and the presence of 'Do Not Attempt Cardiopulmonary Resuscitation' orders were recorded separately. Results: Among 6072 patients presenting with an acute medical emergency, 290 patients (4.8%) had an ACP that was available for the admitting medical team. The prevalence of ACP was higher at 12.6% for patients over 90 years old. Comparing the effect of location for older patients showed that for patients over 90 years old, 25.3% of patients in institutional care had ACP whereas 8.7% of patients admitted from home had ACP. However, in patients above the age of 90 who were being re-admitted after a hospital admission within the previous 30 days, just 15.3% had evidence of ACP. Conclusion: Very few patients have an ACP that is available to admitting medical teams during an unscheduled hospital admission. Even among patients with advanced age, and who have recently been in hospital, the prevalence of available ACP remains low, in spite of national guidance. Further interventions are needed to ensure that patients' wishes for care are known by providers of acute medical care. Funding Statement: The authors stated that: This study was unfunded. Declaration of Interests: No conflicts of interest declared by the authors. Ethics Approval Statement: The authors declared that ethics committee approval was not required for this study.