PP-57 Missed opportunities for NHS continuing health care fast track funding referrals

Introduction Continuing Health Care Fast Track (CHCFT) funding facilitates care at the end-of-life but relies on timely recognition of dying. The Supportive and Palliative Care Indicators Tool (SPICT) is the most validated hospital prognostic tool supporting early recognition of dying. Aims Compare characteristics of patients ‘recognised’ as dying with a CHCFT referral against a time-matched cohort who died within twelve weeks of discharge without CHCFT (‘unrecognised’) and assess whether SPICT indicators were overlooked. Methods All patients who died within twelve weeks of hospital admission (1 March–30 April 2024) at University Hospitals Bristol and Weston NHS Foundation Trust without an inpatient CHCFT referral were reviewed (n=352). A comparison group referred for CHCFT during the same period (n=81) was identified. Demographics, length of stay (LOS), survival time and palliative care referrals were analysed. The non-CHCFT cohort was randomised and 176 records (50%) reviewed; after exclusions (incomplete data (89), transfers (5), miscoding (38), pre-existing CHCFT (11)), 33 remained. SPICT was applied retrospectively to the first-admission by three independent clinicians. Results Non-CHCFT and CHCFT groups had similarities; age (median 78 vs 81 years), deprivation (mean IMD 5.41 vs 5.21) and sex (48.0% vs 58.0% female). Median LOS was 5-days (non-CHCFT) versus 22-days (CHCFT). Median survival (admission–death) was 52-days versus 35-days; palliative care referrals occurred in 17.9% versus 79.0%, respectively. Among eligible non-CHCFT patients (n=33), 63.6% met SPICT criteria for poor prognosis at discharge; 57.1% were eligible for CHCFT but not referred. Conclusions Non-CHCFT and CHCFT groups were similar, with short prognoses (52 v 35-days), but large differences in LOS (5 v 22-days) and palliative care referral (17.9% v 79%). 63.6% of ‘unrecognised’ dying patients had indicators of poor prognosis. Impact The role of SPICT and palliative referral in recognition of dying and equitable CHCFT access needs further investigation.