Assessing the Impact of the Introduction Of Advance Care Planning In Nursing Home Residents Admitted to Hospital

Abstract

Background Nursing home residents may present inappropriately to the Emergency Department at the end of life (EOL). Appropriate advance care planning (ACP) may reduce these presentations. Inpatient teams are in a position to discuss, document and support these ACPs for nursing home residents admitted under their care. Methods Building on existing inpatient and outreach specialist pathways in a model three hospital, formal ACPs were introduced for all inpatients from Jan 2024 admitted from a nursing home where it was deemed clinically appropriate. The completed advance care plan included decisions re cardiopulmonary resuscitation, level of intervention (including hospital transfer), antibiotics, fluids, nutrition plan and medications to support EOL care. ACP discussions took place with the consultant geriatrician, patient, nominated family/patient support and director of nursing. Data on discharged patients (including presence of ACP on discharge) was collected and analysed for emergency re-presentations. Results Of 137 patients discharged back to their nursing homes in the first 4 months of 2024, 41 (30%) had an ACP in place while 96 (70%) did not. Of those with ACP in place, 6/41 re-presented to Emergency Department within this timeframe vs 17/96 who were discharged without an ACP (15% vs 18%, p=0.66). However, only 3/41 with ACP were re-admitted to hospital from the emergency department vs 15/96 without an ACP (7% vs 16%, p=0.19). No patients discharged with an ACP re-presented and subsequently died in hospital, while 1/96 (1%) of those discharged without an ACP died in hospital after re-presentation. Conclusion ACP discussion did not reduce re-presentations to hospital but there was a non-significant trend towards a reduction in re-admissions. Overall, there was an extremely low rate (1/137, 0.7%) of patients re-presenting to hospital and dying during that admission. Further work is ongoing to examine the criteria that would prompt ACP discussion in nursing home residents admitted to hospital.