74 Advance care planning in hospital fast track discharge patients: a quality improvement project

Introduction There is national focus on earlier identification of patients in their last year of life and allowing them to express their preferences through the process of Advance Care Planning (ACP). Despite training on prognostic models, many clinicians find it difficult to identify which patients are suitable for ACP discussions. Expedited hospital discharges utilising NHS Continuing Care Fast Tracking potentially provide an opportunity to undertake and record ACP, as these patients are anticipated to be approaching the end of life. The aim of this project was to increase the number of ACP discussions in Fast Track discharge patients. Method This project took place using a Plan, Do, Study, Act approach in three-month iterative cycles. Fast track discharge patients were identified from databases held by the palliative care and discharge teams. The electronic hospital records of patients identified from both databases were reviewed retrospectively to determine if there was any evidence of ACP. The Co-ordinate My Care (CMC) database was accessed to see if the patient had a CMC record. Results Overall, the results showed an overall increase in ACP/CMC from 40% at baseline to 55% at 3 months, 98% at six months, 98% at nine months and 100% at 12 months. This improvement was due to: Education and training to junior doctors on ACP/CMC Revision of the hospital’s ACP proforma to improve quality of information shared Simplification of the ACP/CMC process within the hospital resulting in improved communication with external organisations Addition of a prompt regarding completion of ACP/CMC onto NHS Continuing Care Fast Track tool paperwork Conclusion Expedited hospital discharges utilising NHS Continuing Care Fast Tracking provide an opportunity to undertake and record ACP. Undertaking ACP discussions at this point in the patient‘s care appears to be acceptable to both patients and healthcare professionals.