Introduction: In 2021, SA Health funded the Regional Hospice in Residential Aged Care Facility (RHRACF) project. As one of the objectives of this project was to reduce hospital admissions in the last seven days of life for residents living in RACFs, the RHRACF project staff approached this in various ways. For instance, they delivered on-site education and mentoring by a qualified palliative care nurse educator and monthly palliative care specialist-led Needs Rounds to discuss residents' palliative needs. In addition, the funding allowed for the support of 15 regional RACFs. Critically, the project team encouraged local nursing staff to complete ELDAC After-Death-Audits at each site before the project commences and to continue doing so after the project commenced. 

Aim: This paper uses the ELDAC after-death audit to compare the rate of hospital admissions in the last seven days of life of residents before the project commenced with those that occurred during the project. Furthermore, it identified the factors that influence hospital admission. 

Methods: on-site RACF staff collected ELDAC After-Death-Audits for residents who had died at the nominated sites in the previous six months (baseline). Audits continued after the commencement of the project activities (active). We compared the frequency of hospital admissions in the last seven days of life from the two resident cohorts. Furthermore, we studied the data to understand the reasons for hospital admissions in each group.

Results: The proportion of residents transferred to hospital in the last seven days of life decreased from 16% in the baseline group to 9% in the active group (p=0.13). While this was not statistically significant, multiple linear regression demonstrated significant changes to the main reason for hospitalisation. For instance, while residents mainly were transferred prior to the project commencing for symptom management (57%), this was primarily due to falls (30%) and sudden unexpected deterioration (30%) after the project commenced (p=0.016). This shift in reasons for transfer indicates greater confidence in staff skills in managing terminal symptoms. 

Conclusion: These results suggest value in the RHRACF project, resulting in a significant shift in the reason for hospital transfer in the last seven days of life. This project ensures that regionally based RACF residents have timely access to a skilled workforce empowered to deliver good palliative care. Furthermore, using the ELDAC after-death-audits provided valuable information about the resident's care in all RACFS.