105 A retrospective case note review of hospital admissions for patients under the care of the central Manchester community specialist supportive and palliative care team (CSSPCT), with a focus on preventable admissions

<h3>Introduction</h3> Over 1/4 of inpatient may be within the last year of life.¹ In 2021, almost 3/4 (72%) of people who died were hospitalised within 6 months of death.² The NHS Long-Term Plan aims to reduce avoidable hospital admissions for dying patients.³ Central Manchester serves areas of extreme socioeconomic deprivation and health inequalities, with large numbers of immigrants and single household populations.^{4 5 6} Higher admissions are to be expected.⁷ There is no geographically convenient hospice, with deaths there nearly 1/3 of England averages.⁸ As lower numbers than England averages die in nursing homes more deaths occur at home or in hospital8. Shifting care from the hospital into the community for these patients saves 50% for provision of the palliative care, in addition to the cost saving for the inpatient stay.⁹ Even larger savings (94%) are noted when compared with hospice care.⁹ A surrogate marker for good palliative care is if patients die in their preferred place of death (PPD).¹⁰ <h3>Method</h3> A retrospective case note review of 25 patients under the CSSPCT in central Manchester admitted to hospital in July 2023 and 2024. <h3>Results</h3> 20% were deemed avoidable (n=5) and 28% (n=7) may have been prevented with senior review. Factors associated with avoidable admissions were a lack of social support and lack of timely palliative care review and advance care planning (ACP). 12% (n=3) of all patients admitted died during the admission, one did not achieve their PPD as a result. Of those that were admitted and subsequently died, 66% (n=2/3) had missed ACP opportunities prior to admission. <h3>Conclusion</h3> Factors which could prevent hospitalisation for these vulnerable patients are enhanced senior decision makers to support community teams, responsive reviews and proactive ACP. Work is underway to improve these, which we hope will ultimately help facilitate patient’s choices for care and death. <h3>References</h3> NHS England. About palliative and end of life care. Accessed 16/10/24. Available at: https://www.england.nhs.uk/eolc/introduction/ Office for Health Improvement and Disparities. Palliative and end of life care factsheet: Patterns of care, England 2021. Patterns of care related to 4 major conditions: cancer, dementia, cardiovascular disease and respiratory disease. Version 2 Accessed online 16/10/24 at: https://fingertips.phe.org.uk/documents/peolc_patterns_of_care_factsheet_2021.html The NHS Long Term Plan, England 2019m p25. Accessed online 16/10/24 at: https://www.longtermplan.nhs.uk/publication/nhs-long-term-plan/ 4 Codling K and Allen J, Health Equity in Greater Manchester: The Marmot Review 2020. London: IHE, 2020. Accessed online 16/10/24. Available at:https://www.instituteofhealthequity.org/resources-reports/greater-manchester-evaluation-2020/greater-manchester-evaluation2020.pdf Marmot M, Allen J, Boyce T, Goldblatt P and Morrison J. Build Back Fairer in Greater Manchester: Health Equity and Dignified Lives. London: IHE, 2021. Accessed online 16/10/24. Available at: https://www.instituteofhealthequity.org/resources-reports/build-back-fairer-in-greater-manchester-health-equity-and-dignified-lives ONS Explore Local Statistics. Accessed online 16/10/24. Available at: https://explore-local-statistics.beta.ons.gov.uk/areas/E08000003-manchester Luben R. <i>et al</i>. Residential area deprivation and risk of subsequent hospital admission in a British population: the EPIC-Norfolk cohort. <i>BMJ Open</i> 2019; DOI: 10.1136/bmjopen-2019–031251. Accessed online 16/10/24. Available at: https://bmjopen.bmj.com/content/bmjopen/9/12/e031251.full.pdf Atlas of Variation for Palliative and End of Life Care in England. Accessed online 16/10/24. Available at: http://tools.england.nhs.uk/images/EOLCatlas/atlas.html Murtagh FEM, Guo P, Firth A, et al. A casemix classification for those receiving specialist palliative care during their last year of life across England: the C-CHANGE research programme. Southampton (UK): National Institute for Health and Care Research; November 2023. Accessed online 16/10/24. Available at:https://pubmed.ncbi.nlm.nih.gov/38048413/ 10 van Doorne I, van Rijn M, Dofferhoff SM, Willems DL, Buurman BM. Patients‘ preferred place of death: patients are willing to consider their preferences, but someone has to ask them. <i>Age Ageing</i>. 2021;<b>50</b>(6):2004–2011. doi:10.1093/ageing/afab176. PMID: 34473834; PMCID: PMC8581384. Accessed online 16/10/24. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC8581384/ Advance care planning in patients referred to hospital for acute medical care: Results of a national day of care survey, Knight, Thomas et al. <i>EclinicalMedicine</i>;<b>19</b>:100235. Feb 2020. Accessed online 16/10/24. Available at:https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30240-8/fulltext