103USE OF VALIDATED SCREENING TOOLS TO IDENTIFY END OF LIFE PATIENTS ON THE ACUTE MEDICAL TAKE

Abstract

Evidence Base: The majority of deaths are due to a progressive decline in health and accumulated deficits, so should therefore be predictable. Early identification allows tailored palliative care that incorporates patients' and families' wishes. Change Strategies: We conducted a 2-week retrospective and 1-week prospective audit interspersed by a period of education and intervention at St Mary's hospital, Imperial College Healthcare trust. We screened all medical admissions using the specific and general markers from The Early Identification and Prognostication tool and conducted a more detailed review of patients with at ≥2 markers. Our intervention included staff education and the use of The Early Identification and Prognostication questions as a screening tool by the Older Persons Assessment and Liaison team. Change Effects: Around 1/5th of our medical take screened positive in both arms of the audit. Levels of advance care planning and previous escalation discussions were poor despite a high rate of recurrent admissions. Patients screening positive on the tool had a high rate of death within 3 months, readmission or institutionalisation. Following intervention, there were improvements in DNAR documentation within 48 hrs (46.9% vs 41.2%) and treatment escalation plan documentation (46.9% vs 35.3%). We found that poor performance status and carer dependence were the strongest markers for death, fast track and readmissions in both arms of the audit. Conclusion: Our audit shows there is still room for improvement with regard to identification of patients nearing the end of their life in our hospital, but using specific and general prognostication markers can identify those likely to die within 3 months, which can reduce readmissions through appropriate fast track discharge and advance care planning. Being able to identify patients in the final stage of their life will also allow us to make appropriate resuscitation and escalation decisions and provide good quality palliative care.