309 The Growing Need for Advance Care Planning Discussion: An Admission to Die for?

• Published in: Age and ageing 2019-09, Vol.48 (Supplement_3), p.iii17-iii65
• Main Authors: McFeely, Aoife, Small, Cliona, Hyland, Susan, O'Keeffe, Jonathan, Hughes, Graham, O'Shea, Diarmuid
• Format: Article
• Language: English
• Subjects: Advance directives; Care plans; Decision making; Emergency admissions; End of life decisions; Frail; Hospice care; Hospitalization; Inappropriateness; Integrated care; Length of stay; Medical prognosis; Nursing homes; Older people; Palliative care; Patient admissions; Readmission; Teams
• ISSN: 0002-0729; 1468-2834
• DOI: 10.1093/ageing/afz103.199

Background Older people living in nursing homes (NHs) are among the most frail and vulnerable in our community. Over the last 5 years, a review of our local NH admission database revealed a 7% increase in the number of unscheduled hospital attendances from NHs (1015 in 2012/13 vs 1435 in 2016/17). Additionally we have seen an increase in the number of NH residents experiencing ≥2 unscheduled re-admissions within one year (21.1% in 2012/13 vs 30.45% in 2016/17). Our aim was to examine the proportion of patients from NHs who died within 24 hours of presentation, prompting a review of methods that could prevent inappropriate hospital transfers and promoting dignified and comfortable end of life care. Methods A prospective database was collected between 01/01/2016 - 31/12/2017. This recorded all emergency admissions of older people from NHs recording length of stay, readmission rates and mortality. The data was retrospectively analysed, looking specifically at patients who died in hospital ≤ 24 hours Results Of 1435 ED admissions, 49 patients (3.4%) died in hospital ≤ 24 hours after presentation. Of these, 31 patients (61%) died in palliative care suites. 8 patients (16.3%) died in the ED. Conclusion A small number of NH residents presenting to our hospital died within 24 hours. A large proportion of these patients died in a palliative care suite, suggesting poor prognosis was identified rapidly after presentation. We wonder if some of these hospital transfers were avoidable and could certain patients have experienced less disruptive deaths in their NHs? Advanced Care Planning can be difficult for all involved. However, it plays an essential role in ensuring people receive the right care, at the right time, in the right place, from the right team. We support the collaborative roles of a palliative care CNS or Geriatric ANP, and integration with NH Outreach services, to facilitate early decision-making and promote better end of life care.