PP-20 Embedding clinical frailty scoring (CFS) and advance care planning (ACP) on a general medical ward: a quality improvement project

<h3>Introduction</h3> All adults approaching the end-of-life should have opportunities to discuss ACP.¹ CFS is a reliable predictor of outcomes,² and high scores should trigger ACP discussions. Despite almost one-third of hospital inpatients being in their last year of life,³ in practice ACP is rarely offered to those not known to palliative care teams. <h3>Aims</h3> Promote use of CFS as a trigger to offer ACP. Increase the percentage of patients with CFS ≥7 offered ACP by generalist medical teams, embedding this as normal practice. <h3>Method</h3> We conducted a retrospective audit of inpatients on a general medical ward looking at: CFS recording; Proportion of patients with CFS ≥7; Offering of ACP for patients with CFS ≥7. Subsequent interventions over two PDSA cycles included bite-sized education sessions for staff and introducing a column on the ward’s whiteboard to prompt consideration of ACP at board round. We surveyed doctors’ experiences of how the project impacted offering ACP. <h3>Results</h3> An average of 18–30% of inpatients had a CFS of ≥7; of which 52% died and 17% were readmitted within 3 months. Our interventions increased the proportion of patients with CFS ≥7 offered ACP from 17% to 50% and no patients with an ACP were readmitted to hospital. The survey revealed that our interventions significantly increased general medical doctors’ confidence in conducting ACP discussions and the likelihood they would offer ACP in future. <h3>Conclusion</h3> Specialist palliative care and frailty services don’t have the capacity to review all frail patients (numbers of which are increasing).⁴ Simple educational/practical interventions can significantly increase the proportion of frail patients offered ACP by generalists and can reduce hospital readmissions. <h3>Impact</h3> Our interventions demonstrate how simple changes can empower generalists to offer ACP, thus reducing inequity of care for patients who aren’t reviewed by specialist teams. <h3>References</h3> ‘Universal Principles for Advance Care Planning (ACP)’ (2022). Available at: www.england.nhs.uk/eolc/resources/. (Accessed: 6 October 2024). Wallis SJ. <i>et al</i>. ‘Association of the clinical frailty scale with hospital outcomes’, QJM: monthly journal of the association of physicians. <i>QJM.</i> 2015;<b>108</b>(12): pp. 943–949. doi: 10.1093/QJMED/HCV066. Clark D. <i>et al</i>. ‘Imminence of death among hospital inpatients: prevalent cohort study’, palliative medicine. <i>Palliat Med.</i> 2014;<b>28</b>(6): pp. 474–479. doi: 10.1177/0269216314526443. Walsh B. <i>et al</i>. ‘Frailty transitions and prevalence in an ageing population: longitudinal analysis of primary care data from an open cohort of adults aged 50 and over in England, 2006–2017’, age and ageing. <i>Age Ageing.</i> 2023;<b>52</b>(5). doi: 10.1093/AGEING/AFAD058.