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<h3>Introduction</h3> • 30% of deaths in over 75-year-olds occur in care homes; on average patients die within 18 months of admission to a care home. • Patients in their last year of life should be offered the opportunity to complete an Advance Care Plan (ACP). • Our aims were to assess whether ACPs were followed; also to evaluate events surrounding the hospital admission. <h3>Method</h3> • Patients admitted from care homes to the Emergency department (ED) between October 2023-August 2024 • Retrospective analysis of electronic patient records • Data entry and analysis via Excel <h3>Results</h3> • 53% had an ACP in place; treatment was inconsistent with their wishes in 24% of cases • 28% were clinically assessed prior to admission • 30% had >3 admissions in the previous 12 months • Commonest presenting complaint was shortness of breath (SOB) • 32% had an avoidable admission; 68% had an unavoidable admission of which 62% required oxygen +/- IV antibiotics +/- IV fluids • 22% received end of life care in hospital <h3>Conclusion</h3> • Only 53% of patients had an ACP in place, representing opportunity for improvement. • Only 28% of patients were assessed face to face prior to ED-a potential opportunity to reduce unnecessary hospital admissions. • 1/3 of patients had an avoidable admission (combined length of stay 216 days) • The commonest reason for admission was SOB. The majority of unavoidable admissions were for IV antibiotics +/- fluids +/- oxygen. Improved symptom management, earlier clinical assessment and increased provision of IV medication and oxygen in the care home setting may facilitate the care of a more patients in the community. • 22% of the patients died in hospital. With improved collaboration between the acute and community sectors, it may be possible to reduce hospital deaths. <h3>Outcomes</h3> • In-Reach post (cross boundary nurse linking community & acute) • Care home ACP support worker • Frailty phone (Community services) • Consultant connect (Ambulance service)