Abstract
Background
Advanced care planning (ACP) allows patients to discuss their wishes for future care. In London, the Universal Care Plan (UCP) allows ACPs to be shared digitally between healthcare professionals in the community and secondary care. Inpatient admission provides an opportunity for ACP discussions, and documentation via a UCP on discharge.
Methods
We audited pre-existing UCPs in all patients admitted to an inpatient geriatric ward between May and October 2024.
We then conducted 3 PDSA cycles to promote ACP discussions during admission, and documentation via new or updated UCPs.
- PDSA cycle 1: template created for consultant ward rounds to prompt identification of whether patients might be appropriate for ACP.
- PDSA cycle 2, visal prompt created as a reminder to use the template.
- PDSA cycle 3, teaching session delivered to rotating doctors to highlight the template and UCP forms.
We also followed up patients to identify how frequently patients were readmitted or died.
Findings
We found that a minority of patients were admitted with a UCP in place.
After PDSA cycle 1, 21% of patients were discharged with a UCP. After PDSA cycle 2, this number increased to 47% .
After PDSA cycle 3, over half of patients were discharged with a UCP in place.
Within 3 months of discharge, 28% of patients were readmitted and 10% of patients died.
Conclusions
The template created a structure to promote the use of ACP, and the number of patients discharged with a UCP increased following our interventions . However, there remains a high burden of readmission to hospital.