Background Nursing home residents may present inappropriately to the Emergency Department at the end of life (EOL). Appropriate advance care planning (ACP) may reduce these presentations. Inpatient teams are in a position to discuss, document and support these ACPs for nursing home residents admitted under their care. Methods Building on existing inpatient and outreach specialist pathways in a model three hospital, formal ACPs were introduced for all inpatients from Jan 2024 admitted from a nursing home where it was deemed clinically appropriate. The completed advance care plan included decisions re cardiopulmonary resuscitation, level of intervention (including hospital transfer), antibiotics, fluids, nutrition plan and medications to support EOL care. ACP discussions took place with the consultant geriatrician, patient, nominated family/patient support and director of nursing. Data on discharged patients (including presence of ACP on discharge) was collected and analysed for emergency re-presentations. Results Of 137 patients discharged back to their nursing homes in the first 4 months of 2024, 41 (30%) had an ACP in place while 96 (70%) did not. Of those with ACP in place, 6/41 re-presented to Emergency Department within this timeframe vs 17/96 who were discharged without an ACP (15% vs 18%, p=0.66). However, only 3/41 with ACP were re-admitted to hospital from the emergency department vs 15/96 without an ACP (7% vs 16%, p=0.19). No patients discharged with an ACP re-presented and subsequently died in hospital, while 1/96 (1%) of those discharged without an ACP died in hospital after re-presentation. Conclusion ACP discussion did not reduce re-presentations to hospital but there was a non-significant trend towards a reduction in re-admissions. Overall, there was an extremely low rate (1/137, 0.7%) of patients re-presenting to hospital and dying during that admission. Further work is ongoing to examine the criteria that would prompt ACP discussion in nursing home residents admitted to hospital.

中文翻译：

---

评估在入院疗养院居民中引入预先护理计划的影响


背景 疗养院居民在临终 (EOL) 时可能会不适当地前往急诊室。适当的预先护理计划 (ACP) 可能会减少这些症状。住院团队能够为接受他们照顾的疗养院居民讨论、记录和支持这些 ACP。方法 以三级医院现有的住院患者和外展专家途径为基础，自 2024 年 1 月起，对从临床上认为合适的疗养院收治的所有住院患者引入正式的 ACP。完成的预先护理计划包括心肺复苏的决定、干预水平（包括医院转移）、抗生素、液体、营养计划和支持 EOL 护理的药物。 ACP 与老年病学顾问、患者、指定家庭/患者支持人员和护理总监进行了讨论。收集并分析出院患者的数据（包括出院时是否存在 ACP）以用于紧急情况的再现。结果 2024 年前 4 个月，137 名患者出院返回疗养院，其中 41 名 (30%) 患者安装了 ACP，而 96 名 (70%) 没有安装。在已实施 ACP 的患者中，6/41 人在此时间范围内再次到急诊室就诊，而未实施 ACP 则出院的患者为 17/96（15% vs 18%，p=0.66）。然而，只有 3/41 的 ACP 患者从急诊科再次入院，而没有 ACP 的患者为 15/96（7% vs 16%，p=0.19）。没有 ACP 出院的患者再次就诊并随后在医院死亡，而未 ACP 出院的患者中有 1/96 (1%) 在再次就诊后在医院死亡。结论 ACP 讨论并未减少再次入院的情况，但再次入院的减少趋势并不显着。 总体而言，入院期间再次入院并死亡的患者比例极低（1/137，0.7%）。进一步的工作正在进行中，以检查促使入院疗养院居民进行 ACP 讨论的标准。