PROCEDURES IN THE LAST WEEK OF LIFE FOR DEATHS IN HOSPITAL (COMPARING PRE- AND MIDCORONAVIRUS- 19 TIME PERIODS)

ABSTRACT

Background The Gold Standards Framework1 (GSF) was introduced in The Dudley Group NHS Foundation Trust (DGFT) in 2018;to encourage identification of those at the end of life and promote individualised advanced care planning including consideration of procedures in the last days of life. Method Retrospective audit to look at procedures conducted in the last week of life for patients who died at DGFT. Due to the coronavirus-19 pandemic, a period in Autumn 2019 prior to the pandemic and then a second period during the first-wave in Spring 2020 was studied. A list of adult patients who were coded as having a procedure in the last week of their admission, where the discharge method was death (occurring in November 2019 or April 2020) was compiled by the Informatics Team and information collected from notes using a proforma. Results The majority of patients in both the 2019 (64%) and 2020 (69%) audit had lengths of stays of 7 days or less (they died within a week of admission). Over 90% of patients in both groups had blood tests and imaging. Approximately 50% of patients had at least one admission in the 3 months prior to their final admission in the 2019 group, however, this was half (24%) in the 2020 group. Approximately 40% in both groups had been identified as GSF red or amber, however, up to 80% had documentation indicating recognition that in last year of life and evidence of good communication. Conclusions Implementation of the Gold Standards Framework has provided a structure to support identification of patients in the last year of life. In view of the number of admissions prior to the final admission there needs to be continued work to identify patients in a timely manner to support with the development of an individual plan of care.