Abstract
Introduction:
Recurrent episodes of aspiration pneumonia (RAP) are a significant problem in frail patients leading to high re-hospitalization and mortality rates. Anticipatory care planning (ACP) enables improved quality of life and end of life care. We reviewed the assessment, ACP discussions and communication with Primary Care for patients admitted with RAP.
Methods:
We used PDSA methodology, reviewing patients with RAP referred to Speech and Language Therapy (SLT) in Elderly Medicine wards.
Educational interventions were implemented. An illustrative case and pre-intervention results were presented at an online hospital-wide seminar and subsequently at an online departmental medical teaching session. Our second round of interventions included departmental induction teaching for newly rotated doctors and the creation of an electronic ACP document (RAP ACP).
Post-intervention analyses were conducted after both rounds of intervention.
Results:
Baseline data was collected from 116 patients (mean age 85, 47% female). Post intervention data was collected from 10 patients (mean age 88, 70% female) and subsequently 25 patients (mean age 88, 32% female).
Baseline data demonstrated need for improvements in Mental Capacity Assessment (MCA) documentation (21.5%), ACP completion (26.7%) and flagging patients suitable for Gold Standards Framework (GSF) on discharge (15%).
Following educational interventions, there was a substantial improvement in MCA documentation (80%) and completion of ACP discussions (70%). Communication of patients eligible for GSF remained similar (14.2%).
Following our second interventions there continued to be improvement in MCA documentation (28%) and ACP completion (52.2%) although not as marked. Communication of patients eligible for GSF showed improvement (31.6%).
Conclusions:
Educational interventions substantially improved the quality of individualised care provided in the short term. Mortality was high and further interventions targeting ACP completion and discharge communication are indicated.