Discharge Letters Research Articles

Nutritional follow-up in children after discharge: Organisation in a tertiary care centre.

Aiming to improve the standard of care for patients with a nutritional intervention, we evaluated how nutritional follow-up (FU) is organised at discharge and after 6 months. From 16 November 2020 until 20 December 2020, we retrospectively included patients admitted for > 1 day to the general ward of a tertiary hospital. Medical charts were reviewed for demographics, anthropometric measurements and nutritional interventions (e.g., tube, parenteral nutrition). Involved healthcare provider (HCP), dietitian and speech and language therapist (SLT) were scored. Nutritional care FU was categorised as in a primary, secondary or tertiary care setting. We included 206 (52.4% male) patients, with a median length of stay of 4 (3-8) days. Prehospitalisation 58 (28.2%) patients had a nutritional intervention compared to 74 (35.9%) patients at discharge. In total, 80 (38.8%) patients received nutritional care FU by a total of 114 HCP, and approximately half (53.5%) were dietitians. FU was mostly conducted by a dietitian in the tertiary care (78.7%) and by an SLT in the primary care (54.5%). For 15 (20.3%) patients, the discharge letter included complete reports of nutritional interventions. At 6 months FU, 26.6% of the children still had a nutritional intervention. Mean weight standard deviation score increased significantly between discharge from the hospital and 6 months FU. A considerable amount of paediatric patients received a nutritional intervention pre- and post-hospitalisation. Nutritional care is organised around a multitude of different HCP; however, not all cases are multidisciplinary. Nutritional care was scarcely reported correctly in the discharge letter.

Follow-up study of infants recruited to the randomised, placebo-controlled trial of azithromycin for the prevention of chronic lung disease of prematurity in preterm infants—study protocol for the AZTEC-FU study

BackgroundPreterm birth, especially at less than 30 weeks’ gestation, is significantly associated with respiratory, neurodevelopmental and growth abnormalities. The AZTEC study has recruited 799 infants born at < 30 weeks’ gestation to determine if a ten-day intravenous treatment with azithromycin improves survival without development of chronic lung disease of prematurity (CLD) at 36 weeks’ post menstrual age (PMA) when compared to placebo. The follow-up studies will compare respiratory, neurodevelopmental and growth outcomes up to 2 years of corrected age between infants who received azithromycin and those who received placebo in the early neonatal period.MethodsSurvivors at 36 weeks’ PMA from the main Azithromycin Therapy for Chronic Lung Disease of Prematurity (AZTEC) study with parental consent will continue to be followed up to discharge from the neonatal unit and to 2 years of corrected age. Length of stay, rates of home oxygen, length of supplemental oxygen requirement, hospital admissions, drug usage, respiratory illness, neurodevelopmental disability and death rates will be reported. Data is being collected via parentally completed respiratory and neurodevelopmental questionnaires at 1 and 2 years of corrected age respectively. Additional information is being obtained from various sources including hospital discharge and clinical letters from general practitioners and hospitals as well as from national databases including the National Neonatal Research Database and NHS Digital.DiscussionThe AZTEC-FU study will assess mortality and important neonatal morbidities including respiratory, neurodevelopmental and growth outcomes. Important safety data will also be collected, including the incidence of potential consequences of early macrolide use, primarily pyloric stenosis. This study may have implications on future neonatal care.Trial registrationThe study was retrospectively registered on ISRCTN (ISRCTN47442783).

Communication of palliative care needs in discharge letters from hospice providers to primary care: a multisite sequential explanatory mixed methods study

BackgroundThe provision of palliative care is increasing, with many people dying in community-based settings. It is essential that communication is effective if and when patients transition from hospice to community palliative care. Past research has indicated that communication issues are prevalent during hospital discharges, but little is known about hospice discharges.MethodsAn explanatory sequential mixed methods study consisting of a retrospective review of hospice discharge letters, followed by hospice focus groups, to explore patterns in communication of palliative care needs of discharged patients and describe why these patients were being discharged. Discharge letters were extracted for key content information using a standardised form. Letters were then examined for language patterns using a linguistic methodology termed corpus linguistics. Thematic analysis was used to analyse the focus group transcripts. Findings were triangulated to develop an explanatory understanding of discharge communication from hospice care.ResultsWe sampled 250 discharge letters from five UK hospices whereby patients had been discharged to primary care. Twenty-five staff took part in focus groups. The main reasons for discharge extracted from the letters were symptoms “managed/resolved” (75.2%), and/or the “patient wishes to die/for care at home” (37.2%). Most patients had some form of physical needs documented on the letters (98.4%) but spiritual needs were rarely documented (2.4%). Psychological/emotional needs and social needs were documented in 46.4 and 35.6% of letters respectively. There was sometimes ambiguity in “who” will be following up “what” in the discharge letters, and whether described patients’ needs were resolved or ongoing for managing in the community setting. The extent to which patients received a copy of their discharge letter varied. Focus groups conveyed a lack of consensus on what constitutes “complexity” and “complex pain”.ConclusionsThe content and structure of discharge letters varied between hospices, although generally focused on physical needs. Our study provides insights into patterns associated with those discharged from hospice, and how policy and guidance in this area may be improved, such as greater consistency of sharing letters with patients. A patient-centred set of hospice-specific discharge letter principles could help improve future practice.

A qualitative formative evaluation of a patient facing intervention to improve care transitions for older people moving from hospital to home.

The Partners at Care Transitions (PACTs) intervention was developed to support older people's involvement in hospital to improve outcomes at home. A booklet, question card, record sheet, induction leaflet,and patient-friendly discharge lettersupport patients to be more involved in their health and wellbeing, medications, activities of daily living and post-discharge care. We aimed to assess intervention acceptability, identify implementation tools, and further develop the intervention. This was a qualitative formative evaluation involving three wards from one hospital. We recruited 25 patients aged 75 years and older. Ward staff supported intervention delivery. Data were collected in wards and patients' homes, through semi-structured interviews, observation,and documentary analysis. Data were analysed inductively and iteratively with findings sorted according to the research aims. Patients and staff felt there was a need for, and understood the purpose of, the PACT intervention. Most patients read the booklet but other components were variably used. Implementation challenges included time, awareness,and balancing intervention benefits against risks. Changes to the intervention and implementation included clarifying the booklet's messages, simplifying the discharge letter to reduce staff burden,and using prompts and handouts to promote awareness. The PACT intervention offers a promising new way to improve care transitions for older people by supporting patient involvement in their care. After further development of the intervention and implementation package, it will undergo further testing. This study regularly consulted a panel representing the local patient community, who supported the development of this intervention and its implementation.

P8.099: Post-operative Myocardial Infarction After Renal Transplant: Setback or Disaster?

Introduction: There is controversy surrounding the role of pre-operative cardiovascular screening for potential transplant candidates. Postoperative myocardial infarctions (MI) are wide ranging in their clinical picture, and a balance is needed between the risk of post operative MI against delayed listing or denial of transplant. Methods: We retrospectively reviewed all adult renal transplant recipients in our centre from 2010 to 2021 to identify patients with MI within 30 days following transplant, based on a diagnosis of an MI in the electronic record, an MI mentioned on the patient discharge letter, or a Troponin I level of 35 or more with a 20% change (from the Fourth Universal Definition of an MI (2018)). We reviewed the patients who had an MI, including past medical history, medications, and pre-operative cardiac investigations. Results: Of the 1627 adult transplant recipients over the 11-year period there were 27 patients who had a post-operative MI. 18 patients were male (67%) and 9 patients were female (33%). The mean age of the patients with an MI was 61.5 years, with a median age of 61 years and minimum of 45. 8 patients were diabetic (30%). Comparing patients over 45, 1-year patient survival was noted to be 96% both in the MI group and the non-MI group, while 5-year patient survival was 68% vs 83%. 5-year uncensored graft survival, including deaths with functioning graft, was 68% vs 74% for recipients without MI. Conclusions: Post- operative MI occurred in 1.6% of transplant recipients but was not associated with significantly reduced 1 year or 5 year patient survival post transplant suggesting that current cardiovascular assessment for transplant results in satisfactory cardiac outcomes post transplant and the risks from delayed listing should be weighed against perceived benefits of asymptomatic screening. Further work is needed to elucidate MACE outcomes in the assessed but non waitlisted population.

Derivation and validation of a 90-day unplanned hospital readmission score in older patients discharged form a geriatric ward.

To derive and validate a 90-day unplanned hospital readmission (UHR) score based on information available to non-hospital based care providers. Retrospective longitudinal study with cross-validation method. Participants were older adults (≥ 65years) admitted to a geriatric short-stay department in a general hospital in France. Patients were split into a derivation cohort and a validation cohort. We recorded demographic information, medical history, and concurrent clinical characteristics. The main outcome was 90-day UHR. Data obtained from hospital discharge letters were used in a logistic regression model to construct a predictive score, and to identify risk groups for 90-day UHR. In total, 750 and 250 aged adults were included in both the derivation and the validation cohorts. Mean age was 87.2 ± 5.2years, most were women (68.1%). Independent risk factors for 90-day UHR were: use of mobility aids (p = .02), presence of dementia syndrome (p = .02), history of recent hospitalisation (p = .03), and discharge to domiciliary home (p = .005). From these four risk factors, three groups were determined: low-risk group (score < 4), medium-risk group (score between 4 and 6), and high-risk group (score ≥ 6). In the derivation cohort the 90-day UHR rates increased significantly across risk groups (14%, 22%, and 30%, respectively). The 90-day UHR score had the same discriminant power in the derivation cohort (c-statistic = 0.63) as in the validation cohort (c-statistic = 0.63). This score makes it possible to identify aged adults at risk of 90-day UHR and to target multidisciplinary interventions to limit UHR for patients discharged from a Geriatric Short-Stay Unit.

Medication‐related problems in geriatric psychiatry—a retrospective cohort study

Information on medication-related problems (MRPs) in elderly psychiatric patients is scarce. In the present study, we analyzed the frequency and characteristics of MRPs in patients ≥60years treated on the gerontopsychiatric ward of Hannover Medical School in 2019. Taking advantage of an interdisciplinary approach, two independent investigators screened hospital discharge letters of 230 psychiatric inpatients for clinically relevant MRPs, followed by validation through an interdisciplinary expert panel. Drug interactions as a subset of MRPs were analyzed with the aid of two different drug interaction programs. 230 patients (63.0% female, mean age 73.7±8.4years, median length of stay 18days) were prescribed a median of 6 drugs. In total, 2180 MRPs were detected in the study population and 94.3% of the patients exhibited at least one MRP. Patients displayed a median of 7 MRPs (interquartile range 3-15). Pharmacodynamic interactions accounted for almost half of all MRPs (48.1%; 1048/2180). The number of drugs prescribed and the number of MRPs per patient showed a strong linear relationship (adjusted R2 =0.747). An exceedingly high proportion of elderly psychiatric inpatients displayed clinically relevant MRPs in the present study, which may be explained by the multimorbidity prevalent in the study population and the associated polypharmacy. The number of drug interactions was largely in accordance with previous studies. As a novel finding, we detected that a considerable proportion of elderly psychiatric inpatients were affected by potential prescribing omissions, potentially inappropriate duplicate prescriptions, and insufficient documentation.

288 Re-Audited QIP on Accuracy of Documentation in the Surgical Notes and Discharge Letter

Abstract Aim To identify and review the discrepancy between the documentation in the surgical operation notes and discharge summaries. To evaluate the surgical operation notes and assess its compliance with the RCS standard. Method Prospective audit of 64 General Surgery operation notes and their respective discharge letters was carried out in two cycles from March- June 2021. Royal College of Surgeons England Good Surgical Practise, 2014 was used to audit the general surgery notes. Teaching sessions were carried out after the first cycle for the use of Electronic Operation Notes. Furthermore, comparison of this audit results with the different trust following Electronic Operation notes were carried out. Results Operation notes and discharge letters were reviewed on variables like date of procedure, quality of performa based on RCSEng guidelines. There was 50% increase in the use of Typed Operation Notes in the second cycle which showed a significant decrease (almost 50%) in the mentioning of incorrect operation dates. 65% of the handwritten notes were not comprehensive enough or legible. However, Electronic operative note had significant adherence to the RCS guideline. When these data were compared to the other trust using Electronic Operation Notes all the highlighted issues were found in a negligible ration. Conclusions As the data suggests that handwritten Operation Notes were not comprehensive and legible hence replacing these with the electronic operation notes would be best practice. Fully compliant electronic operation notes, reducing in variability by opting single and procedure specific Performa will help to mitigate the issues highlighted.

283 Delayed Discharge-a Pitfall for NHS; Can We Improve?

Abstract Aim Identify reasons for discharge delays in a tertiary care hospital and find areas of improvement. Method Data were collected for seven days, and all inpatients (Elective and Emergency) admissions were included. Patient's demographic data, length of hospital stay, and discharge data were entered on Microsoft Excel and analysed using SPSS. Results Out of 102 total patients, 48 (47.1%) were male and 54 (52.9%) females. Mean age was 60.5 years (min 20 max 91). Clinical frailty score (CFS) was not calculated in more than half of the patients (n=55, 57.4%). 47(46.5%) patients had polypharmacy. 61(59.80%) patients did not have a documented Expected date of Discharge (EDD). Median hospital stay was 10 days (1–161 days). 27(26.47%) patients had delayed discharge (mean 4.93 days, median 1 day). Reasons for delay included unavailability of rehab bed (n=5, 4.9%), stoma nurse review (n=6, 5.88%), and awaiting bloods, diabetic control or discharge hub planning (n=3, 2.94%). Delayed discharges do not seem to be affected by polypharmacy (p=0.067), DNACPR (p=0.926), frailty score (p=0.761) or gender (p=0.518). However, Patients aged 65 or above were more likely to have delayed discharge (p=0.037). Conclusions Delayed discharge is more likely in over 65years. We recommend early identification of at-risk patients. Possible interventions to avoid discharge delays are EDD, pre-emptive preparation of discharge letters, early morning bloods and training of ward nurses for stoma care.

100 Triaging Two Week Wait Referrals According to ABS Guidelines Established During the COVID-19 Pandemic Is Safe Practice

Abstract Aim CoVid-19 has affected healthcare globally, disrupting cancer care. Two weeks wait (2ww) breast cancer referrals were triaged according to Association of Breast Surgery (ABS) guidelines with patients with no red flag symptoms deemed low risk and able to be discharged back to their GP. This study aimed to assess the safety and efficacy of implementing these guidelines. Method A database was established to prospectively collect 2ww breast cancer referrals from the outset of CoVid-19. Two Consultants triaged the referrals and if there was disagreement, a third Consultant arbitrated. Data were recorded for patient age, gender, presenting complaint, assessment, investigations, diagnosis, and outcome and also time from initial referral to discharge letter to the GP. Results 188 patients were referred via the 2ww pathway to St Bartholomew's Hospital from 22/03/2020 to 08/04/2020. 43 (22.9%) were discharged with a median age of 34 (22–83 years) at the time of referral. The mean time from referral receipt to response was 12.1 (0 – 60 days). 15 (34.9%) patients were subsequently re-referred. Mean time from re-referral to one-stop clinic assessment was 9.1 (2 – 22 days), in keeping with NICE two week wait criteria. Of the patients re-referred, all patients underwent imaging in the form of mammogram and/or ultrasound scan. No patients were found to have pre-invasive or invasive disease. Conclusions Triaging patients based on GP referrals is a safe way of streamlining low risk patients. This has the potential to become standard practice worldwide but requires larger multi-centre studies prior to implementation.

EP-474 An audit of cardiovascular risk modification in patients undergoing major limb amputation for the complications of peripheral atherosclerotic arterial disease and diabetes mellitus

Abstract Introduction The 5-year mortality for patients with peripheral atherosclerotic arterial disease is significant. Major adverse cardiovascular events are common – 16% of patients will have an event within 1-year of the diagnosis. Patients who present requiring major limb amputation represent a group where cardiovascular complications are significant – we have audited how risk is modified for this group at the point of discharge from hospital following treatment. Methods This was a retrospective review of patients admitted for major limb amputation. Specific variables of interest were the prescription of an antiplatelet agent (or oral anticoagulant) and a statin at the time of discharge from hospital. This was defined from immediate discharge letters. Results During the period of interest there were 282 major limb amputations performed and 235 patients were discharged from hospital. Most patients had peripheral atherosclerotic arterial disease (68%). A diagnosis of diabetes was mellitus was also common (52%). In this group of patients many had previous major adverse cardiovascular events – myocardial infarct 21%, angina 16% and previous stroke 18%. At the time of discharge on 80% of patients were prescribed an antiplatelet agent (or anticoagulant) and only 82% of patients had been prescribed a statin. Discussion Pharmacological management of cardiovascular risk in this high-risk group should be improved. At the point of admission a comprehensive assessment of cardiovascular risk should be made and modifiable risk factors addressed.

WE3.3 Discharge delay-A pitfall for NHS; Can we improve?

Abstract Aim Identify reasons for discharge delays from hospital and areas of improvement and any scope for trainees to make a difference – Trainee lead intervention. Method All inpatients including Elective and Emergency admissions were included from all 3 teams over 1 week. Data were collected on Microsoft Excel and analysis done with SPSS. Result Total 102 patients were included (Purple 44, Yellow 40, Red 18). Mean age was 60.5 years. 54 (52.9%) patients were Female. 57.4% data were missed for clinical frailty score (CSF). 46.5%patients had polypharmacy. 61 patients did not have any Expected date of Discharge (EDD). Mean Length of Hospital stay (LOS) is 18.01 days and median 10 (1–161) days. Total 27 patients were delayed. 1 stayed for 161 days awaiting rehab bed. Mean Duration of delay was 4.93 days and Median 1 day (1–42).4 patients were waiting beds outside of hospital for 3, 6,10, &amp;gt;30 days;6 patients were delayed for Stoma nurse review for average 1 day. Delayed discharges do not seem to be affected by polypharmacy (p=0.067), DNACPR (p=0.926), frailty score (p=0.761) or gender (p=0.518), or which team they were on (p=0.801). Discharges are however affected by age(p=0.037). Conclusions Our recommendations were to Identify patient at risk of discharge delay by trainees on admission by CSF, early identification of care requirements with OT/PT, regular EDD review, pre-emptive discharge letter preparation. We also recommended increased resources like training of senior nurses to assess stoma training, phlebotomists/ new clinical support worker to collect early morning bloods, increased Surgical bed capacity.

TU5.11 Do surgical discharge summaries meet national standards? A closed loop clinical audit

Abstract Background High quality health care is information reliant. Access to high quality information in a timely manner is imperative in provision of quality patient care. A national standard for discharge summaries has been developed by the Health Information and Quality Authority (HIQA). A standard for surgical discharge letters is needed to avoid patient readmission, unnecessary presentation to primary care and to ensure continuity of care in the community. The aim is to assess the quality of surgical discharge summaries using the HIQA national Standard. To implement quality improvement strategies recommended by current research. To reassess the quality and close the audit loop. Methods For cycle one of audit, one month of discharge summaries in 2020 were generated across four consultant surgeons at the University Hospital Limerick. 33% of those were sampled evenly across consultants. 60 patient discharge summaries were audited. Training was implemented virtually. For cycle two of audit the same methodology was used, 43 discharge summaries were audited. Results Overall performance was 49%, improved to 69% following training. The worst performing category was future management, 20%, improved to 45%. The best performing categories were auto-populated, patient details 97% and primary care details, 100%. Patient medications were compliant in 25%, improving to 59%. Admission and discharge details were complete in 36% improving to 59%. Clinical narrative was present in 37% improving to 64%. Consultants had not signed off on any letters. Conclusions Surgical discharge summaries audited remain non-compliant with the national standard however, as research shows, NCHD training has improved performance across categories.

How can counselling by family physicians on nutrition and physical activity be improved: trends from a survey in Germany

PurposeCancer and its therapy causes severe symptoms, most of which are amendable to nutrition and physical activity (PA). Counselling on nutrition and PA empowers patients to take part more actively in their treatment. Many cancer patients are yet in need of information on these topics. In this study, we investigate the perception of family physicians (FP) on nutrition and PA in cancer patient care and assess barriers and steps to improve their involvement in counselling on these topics.MethodsBased on qualitative content analysis of 5 semi-structured interviews with FP, a questionnaire was developed and completed by 61 German FP.ResultsMost of the FP acknowledged the importance of nutrition and PA during (91.4%) and after (100%) cancer therapy. While many participants were involved in cancer patient care, 65.6% of FP viewed themselves as primary reference person to address these topics. However, a third (32.8%) of FP were unfamiliar with information thereof. Some were unsatisfied regarding timely updates on their patient’s treatment course via discharge letters (25.0%) or phone calls (36.2%). FP would like to dedicate more consultation time addressing nutrition and PA than they currently do (p < 0.001).ConclusionCommunication btween healthcare practitioners about mutual cancer patient’s treatment must be improved, e.g. utilising electronic communication to quicken correspondence. Acquisition of information on nutrition and PA in cancer patient care needs to be facilitated for FP, approachable by compiling reliable information and their sources. Involvement of FP in structured treatment programs could benefit cancer patient care.Trial registration number(May 7, 2021): 2021–2149-Bef.

Application of intervention mapping to develop and evaluate a pharmaceutical discharge letter to improve information transfer between hospital and community pharmacists.

Insufficient information transfer is a major barrier in the transition from hospital to home. This study describes the systematic development and evaluation of an intervention to improve medication information transfer between hospital and community pharmacists. To develop and evaluate an intervention to improve the medication information transfer between hospital and community pharmacists based on patients', community and hospital pharmacists' needs. The intervention development and evaluation was guided by the six-step Intervention Mapping (IM) approach: (1) needs assessment to identify determinants of the problem, with a scoping review and focus groups with patients and healthcare providers, (2) formulation of intervention objectives with an expert group, (3) inventory of communication models to design the intervention, (4) using literature review and qualitative research with pharmacists and patients to develop the intervention (5) pilot-testing of the intervention in two hospitals, and (6) a qualitative evaluation of the intervention as part of a multicenter before-after study with hospital and community pharmacists. Barriers in the information transfer are mainly time and content related. The intervention was designed to target a complete, accurate and timely medication information transfer between hospital and community pharmacists. A pharmaceutical discharge letter was developed to improve medication information transfer. Hospital and community pharmacists were positive about the usability, content, and comprehensiveness of the pharmaceutical discharge letter, which gave community pharmacists sufficient knowledge about in-hospital medication changes. However, hospital pharmacists reported that it was time-consuming to draft the discharge letter and not always feasible to send it on time. The intervention showed that pharmacists are positive about the usability, content and comprehensiveness. This study developed an intervention systematically to improve medication information transfer, consisting of a discharge letter to be used by hospital and community pharmacists supporting continuity of care.

Careggi Re-Engineered Discharge project: standardize discharge and improve care coordination between healthcare professionals

The hospital discharge process plays a key role for patient care. CaRED (Careggi Re-Engineered Discharge) aimed at establishing a meaningful relationship among General Practitioners (GPs) and patients, throughout the discharge process. In this paper we describe the activities and results in the period 2014 - 2017. CaRED is a restructured discharge protocol, which foresees a different, more direct form of communication between hospital and GPs, enabled by an ad-hoc electronic medical record. The 30-day hospital readmission rate and/or accesses to the emergency department were evaluated as proxy of effective communication. A pre-post survey was launched to assess the GPs' perceived quality, and patient and family satisfaction. A total of 1,549 hospitalizations were included, respectively 717 in the pre and 832 in the post intervention period. The 30-day hospital readmission rate decreased significantly in the post intervention period (14.4% vs 19.4%, χ2(1)=8.03, P<0.05).Eighty-two and 52 GPs participated, respectively, in the pre- and post- survey. In the post-phase the percentage of GPs declaring the discharge letter facilitated the communication on the admission causes (χ2(1)=0.56, P=0.03) and on what to do if conditions change (χ2(31)=19.0 P <0.01) significantly increased, as well as the perception of an easier contact with the hospitalist (χ2(3)=19.6, P <0.01).Two-hundred-eighty and 282 patients were enrolled in the pre- and post- survey. The level of understanding of key parts of the discharge letter (reason for hospitalization, post-discharge therapy, follow-up examinations and how to contact the hospital ward) improved significantly (P <0.01). CaRED significantly improved the discharge process, and became a benchmark for local improvements in communication patterns with GPs.

Health Care Quality in CKD Subjects: A Cross-Sectional In-Hospital Evaluation

Methods The study was performed in a retrospective and observational manner. All adult (age 18 years or older) in-hospital subjects treated from January until December 2019 were included. CKD was diagnosed according to the KDIGO 2012 CKD Guideline. The following variables were assessed: CKD stage, quantification/analysis (yes/no) of blood pressure, proteinuria, serum phosphate, serum 25-OH-D3, ferritin and transferrin saturation, and blood gas analysis. In addition, recommendations of the following medicines were analyzed (given/not given): ACE inhibitor or sartan, phosphate binder, vitamin D3 (activated or native), iron, erythropoietin, and bicarbonate. It was also evaluated whether discharge letters contained CKD-related diagnoses or not. Results In total, 581 individuals were included in the study. The majority of aspects related to the monitoring and therapeutic management of CKD were either considered in only a small proportion of affected individuals (e.g., quantification of PTH − 5.5%/25-OH-D3 − 6%/transferrin saturation − 13.6%) or avoided nearly at all (e.g., recommendation of erythropoietin—1%, documentation of CKD-MBD diagnosis—0.3%). A reasonable quality of care was identified concerning the blood pressure monitoring (performed in 100%) and blood gas analysis (55% of the patients received analysis). Serum phosphate was measured in 12.9%, particularly in subjects at higher CKD stages. Conclusions The current investigation revealed poor quality of care in CKD patients treated at the Brandenburg University Hospital over the period of one year. Quality improvement must be achieved, most likely via a standardized educational program for physicians and a directer access to CKD management guidelines.

Transition to adult services experienced by young people with cerebral palsy: A cross-sectional study.

To assess if young people with cerebral palsy experience and health professionals provide practices that may improve transition from child to adult health services. Seventy-five young people (31 females, 44 males; mean age 18 years 5 months [standard deviation 2 years 2 months]) and/or parents and 108 health professionals completed a questionnaire describing their experience or the provision of nine transition practices. The percentage of young people reporting each practice was: appropriate parent involvement (90%); promotion of health self-efficacy (37%); named worker who supports the transition process (36%); self-management support for physical health (36%); self-management support for mental health (17%); information about the transition process (24%); meeting the adult team (16%); and life skills training (16%). Post-discharge, 10% of young people reported that their general practitioner (GP) received a discharge letter. The percentage of health professionals reporting each practice was: promotion of health self-efficacy (73.2%); self-management support (73.2%); information (69%); consulting the parent and young person about parent involvement (63% and 66%); discharge letter to a GP (55%); life skills training (36%); named worker (35%); meeting the adult team (30%); and senior manager (20%). Many young people did not experience practices that may improve the experience and outcomes of transition. Young people should be involved in the development and delivery of transition to ensure it meets their needs. Many young people with cerebral palsy (CP) do not receive support that may improve the experience of transition. Appropriate protocols and training for health professionals may improve the provision of transition and reduce inconsistency in care between and within organizations. Young people and their families should be involved in service design, delivery, and evaluation related to the transition to ensure it meets their needs.

993 IMPROVING ADVANCE CARE PLANNING ON A GERIATRICS WARD: A QUALITY IMPROVEMENT PROJECT

Abstract Introduction Despite ongoing improvement work in our hospital regarding Advance Care Planning (ACP) in the community and specialist palliative care settings, our team was concerned that ACP was underutilized for inpatients. We aimed to increase the number of ACPs (specifically focusing on re-admission avoidance) made on our geriatrics ward, and to communicate these effectively with community colleagues. Method We retrospectively reviewed 26 deaths on our ward during a three-month period, and found significant missed opportunities to discuss ACP, e.g. 54% of patients had more than one admission in the six months prior to death. We developed a novel co-morbidity score to help support our decision-making, and used aspects of the Gold Standards Framework’s Proactive Identification Guidance. Our working group, led by a consultant geriatrician, focused on increasing the team’s engagement with ACP, including use of an ‘ACP Champion’, and we worked to align our documentation with that used elsewhere in the Trust. We used a paper form, resembling a DNACPR, to prompt community teams to re-consider whether admission was necessary. We made ACPs for six patients during this four-month pilot phase, and followed them up over the next five months. Results Following our interventions, follow-up of our patients showed 83% had ACP described in their discharge letter; 33% had ACP mentioned on their Summary Care Record (SCR); 0% of patients who had died re-presented to hospital prior to death. Conclusion Our project showed that diligent attention to making ACPs for suitable patients was successful in preventing re-admission. Despite this, communication about ACPs in the discharge letters and transfer of this information to the SCR was suboptimal. This demonstrates that even with a focused team, mistakes can happen. I’m now working on a subsequent project focusing on improving understanding of ACP amongst junior doctors.

1079 USE OF AN ADVANCE CARE PLAN CHECKLIST TO IMPROVE COMMUNICATION AND ASSESSMENT OF THE IMPACT ON HOSPITAL READMISSIONS

Abstract Introduction Advance care planning (ACP) is a vital part of holistic and person-centred care. It allows formalising of an individual’s wishes and best interests, and avoids unnecessary or unwanted interventions including, potentially, hospital admissions. It is crucial that any decisions or recommendations are communicated to all relevant healthcare professionals to ensure peoples’ wishes are upheld. We developed this project to review and improve documentation and communication on discharge when a decision had been made to limit care to the community and avoid admission. Method A checklist was developed comprising 11 criteria to be documented in the discharge letter and actions to disseminate information including; updating the ReSPECT form and alerting the hospital frailty and community out of hours teams. We carried out a closed loop audit of patients where admission should be avoided and reviewed discharge letters against the criteria. Where patients were readmitted we reviewed the notes to determine whether the admission was appropriate. Results We compared patients discharged between February 2020–February 2021 and then from March–September 2021. 161 and 27 patients were identified respectively. Average age was 84.6 and 87.3 years respectively. In cohort 2 48.1% of patients were readmitted, up from 8.7% during the previous cycle. 33% of admissions in cohort 2 and 38.9% of readmissions in cohort 1 were deemed appropriate. Documentation improved in 10 of the 11 criteria. Average length of stay for readmissions was reduced from 16.7 to 5.7 days. Conclusion As evidenced by our study utilising a checklist has improved documentation and dissemination of ACPs to the Community. This did not lead to a reduction in hospital admissions but this may have been skewed by factors relating to the Covid-19 pandemic. We did find a significant reduction in length of stay for those subsequently readmitted.