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

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.

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.

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.

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.