Gold standards framework implementation in an acute hospital: end-of-life outcomes.

IF 2.5 4区医学 Q3 HEALTH CARE SCIENCES & SERVICES

BMJ Supportive & Palliative Care Pub Date : 2026-06-29 DOI:10.1136/spcare-2025-005768

Louis Harpham-Lockyer, Joanne Bowen, Holly Sides

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引用次数: 0

Abstract

Objectives: Hospitals remain the most common place of death in the UK, with 30% of inpatients in their last year of life. National policies emphasise early identification and proactive planning to support patients to die in their preferred place. The Dudley Group National Health Service (NHS) Foundation Trust implemented the Gold Standards Framework (GSF) to identify patients nearing the end of life and guide proactive care. This study evaluated whether GSF coding influenced outcomes, specifically advance care planning (ACP) and place of death.

Methods: A retrospective review was conducted of all adult inpatients at a 670-bed UK hospital on 01/09/2023 who died within 12 months. Patients were categorised as GSF-coded or non-coded. Outcomes assessed were evidence of ACP and place of death.

Results: Of 216 patients who died, 104 (48%) were GSF-coded on 01/09/2023. Among those coded GSF Green or Amber (n=71), 54% had documented ACP compared with 13% of non-coded patients. 65% of GSF-coded patients died outside the hospital, compared with 45% of uncoded patients. This trend was consistent for both non-cancer (60% vs 40%) and cancer (76% vs 54%) diagnoses.

Conclusion: GSF implementation and coding support earlier end-of-life identification, greater ACP engagement and fewer hospital deaths, promoting care aligned with patient preferences and potentially reducing hospital-based costs.

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急诊医院的金标准框架实施：生命末期结果。

目标：医院仍然是英国最常见的死亡地点，30%的住院患者在生命的最后一年死亡。国家政策强调早期识别和积极规划，以支持患者在他们喜欢的地方死亡。达德利集团国民健康服务（NHS）基金会信托基金实施了黄金标准框架（GSF），以识别接近生命终点的患者并指导积极的护理。本研究评估了GSF编码是否影响预后，特别是提前护理计划（ACP）和死亡地点。方法：对2023年9月1日在英国一家拥有670个床位的医院12个月内死亡的所有成年住院患者进行回顾性分析。将患者分为gsf编码和非编码。评估的结果是ACP和死亡地点的证据。结果：在216例死亡患者中，104例（48%）在2023年9月1日被gsf编码。在编码为绿色或琥珀色的GSF患者中（n=71）， 54%的患者记录为ACP，而未编码的患者为13%。编码为gsf的患者有65%在医院外死亡，而未编码的患者只有45%。这一趋势在非癌症（60%对40%）和癌症（76%对54%）诊断中都是一致的。结论：GSF的实施和编码支持更早的生命末期识别，更大的ACP参与和更少的医院死亡，促进符合患者偏好的护理，并可能降低医院成本。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

BMJ Supportive & Palliative Care Medicine-Medicine (miscellaneous)

CiteScore

4.60

自引率

7.40%

发文量

170

期刊介绍： Published quarterly in print and continuously online, BMJ Supportive & Palliative Care aims to connect many disciplines and specialties throughout the world by providing high quality, clinically relevant research, reviews, comment, information and news of international importance. We hold an inclusive view of supportive and palliative care research and we are able to call on expertise to critique the whole range of methodologies within the subject, including those working in transitional research, clinical trials, epidemiology, behavioural sciences, ethics and health service research. Articles with relevance to clinical practice and clinical service development will be considered for publication. In an international context, many different categories of clinician and healthcare workers do clinical work associated with palliative medicine, specialist or generalist palliative care, supportive care, psychosocial-oncology and end of life care. We wish to engage many specialties, not only those traditionally associated with supportive and palliative care. We hope to extend the readership to doctors, nurses, other healthcare workers and researchers in medical and surgical specialties, including but not limited to cardiology, gastroenterology, geriatrics, neurology, oncology, paediatrics, primary care, psychiatry, psychology, renal medicine, respiratory medicine.