58 The role of EHCPs in urgent care planning and response for older people approaching the end of life

<h3>Intro</h3> Nationally, there is a sharp increase in admissions in the last 90 days, especially out of hours. Local audits revealed similar findings amongst older patients with frailty in Gateshead. Patients were admitted, despite having completed Emergency Health Care Plans (EHCP) with documented expressed wishes to avoid hospital admission; reasons for this were multifactorial and difficult to fully understand. <h3>Methods</h3> A questionnaire was therefore circulated amongst those involved in the Urgent Care Response for Older People with Frailty in Gateshead, exploring potential barriers to avoiding unnecessary and/or unwanted hospital admission in frail, elderly patients approaching the end of their lives. <h3>Results</h3> The questionnaire had 96 responses from a range of professionals including GPs, district nurses, community nurse practitioners, care home staff, rapid response teams, the ambulance service and members of both frailty and palliative care teams. They had a range of experience in looking after patients with frailty. Respondents identified several barriers to following an EHCP, including vague plans; outdated plans or those not reviewed despite a significant clinical change. They expressed concern that patients might change their mind at the time, or families opinions might differ to that of the patient and/or professional. They responded they often find it difficult to leave care home staff without support for patients with difficult symptoms. They identified a fear of making the wrong decision, of not being fully equipped to decide, alongside challenges with accessing information from other organisations. They identified several potential ways to address these challenges including training, support with decision making at the time of the decision, clearer plans accurately representing patient and family wishes and better communication between organisations. <h3>Conclusion</h3> There are multiple barriers to successfully following plans as documented on an EHCP. A workshop has been planned to further explore and seek ways to address the issues revealed in this questionnaire.