Identifying and coding patients appropriate for the gold standard framework on discharge from an inpatient gastroenterology ward

Background: The Gold Standard Framework (GSF) was first introduced to General Practice in 2000. It is recognised a third of hospital inpatients may be in their last year of life and over the past 25 years there has been evidence to show the GSF reduces hospitalisation and allows more people to live and die in their preferred place of care. Teams undertaking GSF find admissions and lengths of stay are significantly reduced. Our inpatient ward did not have processes to identify those appropriate for the GSF therefore a process to identify and code patients for the community to follow up on discharge was sought. As per the research carried out by the GSF centre the first step to improving care is identifying the appropriate patients for the service which is often overlooked as an inpatient. Aim: To conduct a quality improvement project for identifying and coding patients appropriate for the gold standard framework on the inpatient gastroenterology ward at Salford Royal Methods: Preliminary baseline data collected to review the current coding of GSF patients. The standards were: 1. Patients are identified as having a GSF diagnosis 2. Patients with a GSF diagnosis are coded 3. Patients who are coded are documented on the discharge summary as having a GSF diagnosis to highlight to the community services aiming for a benchmark of 80%. Data collection from March 2024 to July 2024 was collected by retrospectively reviewing documentation, the Salford Royal coding during admissions and discharge summaries. Using the PDSA cycle format; the first intervention carried out was an education session delivered to the gastroenterology trainees and wider MDT. The second intervention was a poster and flow diagram explaining how to identify patients and how to record the GSF on the documentation and discharge letter. Other data collected following the preliminary baseline data was valuable such as whether the hospital palliative inpatient team had been involved, if advanced care planning discussions had been had and whether community palliative care were informed on discharge. Results: Of the 36 patients admitted in the first 2-week period the 11 patients who had a GSF eligible diagnosis were not identified or coded. Following the first and second interventions made 21 further patients were identified as eligible for diagnosis on data collection but no GSF coding was carried out or documentation on the discharge letter. Conclusion: The two interventions received positive feedback, general discussion and engagement among the medical team however it did not lead to patients being coded for the community to identify. The patients who were reviewed in the Specialist liver disease palliative care MDT (SILP) had referrals placed to the community palliative care team and advanced care planning initiated. The SILP is more established currently within the hospital, therefore, our recommendation was to consider implementing a bundle that suggests referral to the SILP and within the bundle asks for the GSF to be coded.