188 Improving the GREAT discharge compliance in fast-track palliative discharges

<h3>Aims</h3> 1. Improve the quality of discharge paperwork for fast-track discharges to transition to community care. 2. Improve advance care planning for patients in their last year of life. <h3>Background</h3> 30% of hospital inpatients are likely in their last year of life1 GREAT is an acronym for the 5 criteria required for good palliative discharge paperwork. 1) Gold Standard Framework database entry, 2) Record of what patient and family understand, 3) End of life medication review, 4) Advance care planning documentation, 5) Treatment escalation plan (TEP). <h3>Method</h3> A 3 cycle QIP auditing ‘Gastro and Liver Unit’ discharge summaries for a given month against the 5 GREAT discharge criteria. Inclusion criteria: fast-track discharges or patients meeting SPICT (Supportive and Palliative Care Indicator Tool) criteria. The first cycle occurred in December 2023 with subsequent cycles in March and May/June 2024 following each intervention. The first intervention introduced GREAT discharge posters to clinical areas, and the Palliative Care Team identifying patients who required GREAT discharge. The second intervention created a ward champion to give consistent education to nurses and doctors, and highlight patients at board rounds to ensure GREAT discharge. <h3>Results</h3> Pre-intervention there was 0% compliance with GREAT discharges, in comparison to 100% compliance following interventions. After the third cycle 48% of patients meeting SPICT criteria had their TEP status documented in their discharge summary, compared with 5% in March 2024. However, only 1% of them had evidence of advance care planning. <h3>Conclusion</h3> Having a ward champion significantly increased the quality of discharge summaries for fast-track patients. The next step is to see if this change can be implemented across the hospital. Advance care planning for patients that meet SPICT remains poor. Ward champions have been allocated across 5 inpatient wards with a structured GREAT inter-departmental teaching program from December 2024. <h3>Reference</h3> Clark D, Armstrong M, Allan A, Graham F, Carnon A, Isles C. Imminence of death among hospital inpatients: Prevalent cohort study. <i>Palliative Medicine</i> 2014;<b>28</b>(6):474–9. Available from: http://www.goldstandardsframework.org.uk/cd-content/uploads/files/Library%2C%20Tools%20%26%20resources/Imminence%20of%20death%20amongst%20hospital%20patients.pdf