20 Improving discharge from hospital for people at the end of life and assessing the quality of handover to primary care

Background Appropriate rapid discharge planning supports discharge to where the person wants to be cared for at EOL. This involves transfer of care over different settings. This evaluation assessed quality of handover and discharge processes from acute hospital setting for patients at EOL. Methods Tri-methodology used. 1. Retrospective cross-sectional survey of electronic discharge summaries/notes for patients discharged for EOLC from acute setting (Aug-Oct 2022). Information included: local EOLC discharge guidance use, presence & quality of palliative care information on discharge, presence & quality of RESPECT form information, discharge Just in case (JIC) medications supplied and documentation of verbal handover if patient discharged to a hospice. Categories aligned to local guidance and NICE guidelines (NG27 NG142. 2. Cross-sectional online survey of all junior doctors to identify experiences and barriers to effective handover. 3. Online Survey of local GP practices for views on handover/discharge information. Results 1. 56 EOLC patients included. 19.6% patients had no palliative care information on discharge letter, 28.6% had minimal and 51.8% had good information. In 68% of cases the discharge letter mentioned the patient was discharged for EOLC. There was minimal information on the RESPECT form in 61%, good quality information in 34% and no RESPECT form in 5% of cases. Appropriate JIC medications were prescribed in 70%. 75% patients transferred to hospice had documented ward verbal handover. 2. Only 10% of junior doctors were aware of the local EOL discharge guidance. Main barriers identified to effective handover were time and job pressures, knowing how to contact GPs and information required. 3. No responses to GP survey received despite requests. Conclusions There are challenges and areas for improvement in communication with primary care to improve discharge of patients at the EOL from hospital. Future work aims to address barriers and improve information provided.