O-14 UNMET NEED IN OUT OF HOURS AND EMERGENCY SUPPORT: SUPPLEMENTARY REPORT FROM THE PALLIATIVE AND END OF LIFE CARE PRIORITY SETTING PARTNERSHIP (PEOLCPSP) Jordan VanGodwin, Stephanie Sivell, Anthony Byrne, Annmarie Nelson. Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK 10.1136/bmjspcare-2015-001026.216 Background This abstract presents supplementary data relating to the number one priority that arose from the 1403 completed responses from the Palliative and end of life care Priority Setting Partnership (PeolcPSP) survey: Out of Hours and Emergency Support. Most respondents, including patients, families and healthcare professionals, gave detailed narrative accounts in response to the survey questions and some of these data were deemed outside the scope of the James Lind Alliance (JLA) protocol as no inter- vention could be identified. Using a thematic analysis applied to the entire data set, we were able to explore the uncertainties, questions and experiences of a wide variety of respondents. Method The 1403 survey responses were coded using the NVivo 10 qualitative analysis software and analysed thematically. Results Responses were categorised in the following sub-themes: (Lack of) Support out of hours; Quality of support; Community services including hospice at home and telephone support net- works Emergency care at the end of life; Coordination of OOH emergency services and Dealing with crisis admissions. Respondents expressed concern over the apparent inadequacy of the current provision of out of hours and emergency support. This led to a number of issues including increased burden for informal carers and inappropriate hospital admissions which lead to greater strain on emergency health care providers (primarily A&E). The responses also highlighted the frustrations of some healthcare professionals over the perceived lack of support and care options during out of hours. Conclusions Respondents described a significant gap in health- care services ability to provide palliative and end of life care out of hours and in emergencies. It is hoped that the publication of these responses can promote further research in this area and have positive practical implications for the future of palliative and end of life care in the UK and Ireland. O-15 PROGNOSIS PREDICTION BY PALLIATIVE PROGNOSTIC INDEX (PPI): MULTI-CENTRE PROSPECTIVE STUDY-2 WITH TWO CALCULATIONS OF PPI IN HOSPICE PATIENTS 1 Sivakumar Subramaniam, 2 Pauline Dand, 3 Martin Ridout. 1 Ellenor, Gravesend, UK; 2 Pilgrims Hospices, East Kent, UK; 3 Statistics Group, SMSAS, University of Kent, Canterbury, UK; 4 St. Joseph's Hospice, London, UK; 5 Wisdom Hospice, Rochester, UK; 6 Heart of Kent Hospice, Maidstone, UK; 7 Hospice in the Weald, Tonbridge, UK; 8 Marie Curie Hospice, Solihull, UK; 9 Greenwich and Bexley Community Hospice, Bexley, UK 10.1136/bmjspcare-2015-001026.217 Background Predicting prognosis accurately would help patients and clinicians to make informed decisions about treatment and referral to appropriate services. But user-friendly tools are lack- ing in clinical practice. The Palliative Prognostic Index (PPI), based on simple clinical indicators, has shown promise in several studies. Aims Following a previous multicentre study in the UK, the cur- rent prospective study involved 10 centres, to check centre-to- centre variability, and included a second assessment of PPI score 3–5 days after admission to investigate whether incorporating changes in PPI lead to improve predictions. Methods PPI score was calculated on admission to inpatient hos- pice, and again 3–5 days later. Kaplan-Meier curves were con- structed and predicted survival based on PPI was compared to actual survival, using standard measures. Results Initial PPI (PPI_1) was recorded for 1164 patients. Median survival for patients with PPI _1 score £4, 4–6 and >6 was 38, 17 and 5 days, but there was significant variation between centres. A second PPI value (PPI_2) was recorded for 962 patients. Most of the remaining patients had high PPI_1 and died before the second assessment. PPI_2 was a more reliable predictor of survival than PPI_1. Based on PPI_2, the sensitivity, specificity, positive predictive value and negative predictive value for prediction for <21 days were 64%, 85%, 84%, 65% and for 42 days were 64%, 77%, 53%, 84%. Again, there was con- siderable centre-to-centre variability. Kaplan-Meyer and ROC curves constructed (Survival <21 days: PPI1: 0.734; PPI2: 0.820. Survival  42 days: PPI1: 0.723; PPI2: 0.795). Further analysis of the effect of changes of score and comparison with recent studies from Taiwan and Japan showed similar results in many aspects. Possible causes of variability of results between centres are discussed. Conclusion PPI score is more accurate if calculated twice and the rate of change of PPI is useful. O-16 WHY DO PATIENTS WITH PALLIATIVE CARE NEEDS PRESENT TO THE EMERGENCY DEPARTMENT? Emilie Green, Sara Shaw, Sarah Ward, Ben Riley, Henna Sattar, Will Brierley, Tim Harris. Bart's Health Trust, London, UK 10.1136/bmjspcare-2015-001026.218 Policy in many countries focuses on preventing hospital admis- sions at the end of life. However, little attention has been paid to the role of the emergency department (ED) in this regard, despite the fact that many hospital admissions among patients with palliative care needs originate in the ED. This paper aims to improve understanding of ED use within a palliative care context. The initial phase of this service evaluation comprised a litera- ture review. Subsequently, the electronic records of all patients known to the specialist palliative care team at Whipps Cross hos- pital presenting to the ED over a three-month period were eval- uated prospectively (n = 112). These quantitative data were analysed using descriptive statistics. Finally, semi-structured inter- views with seven patients from this sample were conducted and thematic analysis was applied. 105 patients made 112 presentations to the ED. 53% were female; the mean age was 73. The two most common presenting complaints were shortness of breath (35%) and pain (28%). There is currently no internationally agreed definition of an appropriate ED presentation; therefore one was established for the purpose of this project. 83% of presentations were deemed to legitimately require ED management. Findings from the qualitative phase highlighted a significant lack of awareness of the availability of alternative services among patients, often resulting in disjointed, inadequate care. Difficul- ties with data sharing between ED and specialty teams and pri- mary and secondary care were observed, often delaying management. Patients perceived the ED to be a safer Abstracts A78 SPCare 2015;5(Suppl 3):A1–A85