41 Advance care planning discussions in vascular patients with critical limb threatening ischaemia not for surgical intervention

<h3>Background</h3> Vascular disease is a major cause of morbidity and mortality worldwide, with an overall one-year mortality of 10%. This is impacted by older age, cancer, and multimorbidity. Advance care planning (ACP) discussions with patients with vascular disease in hospital are challenging due to unpredictable trajectories, multimorbidity, functional decline and recurrent hospitalization. These patients epitomise the need for ACP given the future challenges they face such as chronic pain, repeated infection, psychosocial impact and approaching end of life. <h3>Aim</h3> The aim of this audit was to review ACP discussions held between the vascular team and patients not for surgical intervention of critical limb threatening ischaemia (CLTI) at St George’s University Hospital (SGH), focusing on specific aspects including preferred place of care (PPC) and death (PPD), future antibiotic use, readmission and resuscitation status. <h3>Method</h3> This was a retrospective, snapshot audit collecting data from 36 SGH vascular patients deemed not for surgery and for conservative approach in 2022 and 2023. We compared the data with standards of ACP discussions found in the Gold Standards Framework. <h3>Results</h3> 36 Patients had DNACPR orders, 83% of patients had prognosis discussed but only 75% and 38% respectively were discussed by the vascular team. Palliative Care Team (PCT) led on most ACP discussions (83%) including PPD, PPC and readmission. All patients who achieved their PPD had PCT involvement. Two thirds of patients who discussed readmission opted not for future hospital admissions. 12 patients had antibiotics discussed and vascular led majority of these. <h3>Action Plan</h3> Specific education sessions were developed to build confidence around ACP discussions for vascular clinicians at SGH before reauditing. <h3>Conclusion</h3> Working collaboratively with surgical teams to empower confidence in ACP discussions will not only autonomize patients in their future planning but will impact bed days, readmission rates and overall cost to the NHS.