Implementing and improving the ReSPECT process within medical and orthopaedic departments of a district general hospital

Abstract

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is a process supported by the Resuscitation Council (UK) and UK Royal Colleges to create personalized anticipatory care plans for patients. Hampshire Hospitals NHS Foundation Trust has been an early adopter of this process with variability in engagement with this process across our trust. A quality improvement project was performed to improvement engagement with ReSPECT as well as consistency and quality of documentation. Since patients admitted with fragility fractures are often frail, elderly and at risk of deterioration post-operatively, we focused on improving ReSPECT in the orthopaedic department with medical departments used for comparison post-intervention. Interventions included teaching sessions for consultants and junior doctors, increased senior orthogeriatrician input, and electronic documentation of ReSPECT forms. Post-intervention results revealed an improved engagement with the ReSPECT process with orthopaedic patients with frailty or life-limiting co-morbid conditions more likely to receive early anticipatory care planning as part of their admission process compared to medical inpatients. Senior consultant engagement was key to providing a cultural shift in early anticipatory care planning which helped to foster an environment of open communication among the team, allowing for more effective recognition of frail or co-morbid patients.

Keywords:

• ReSPECT
• SPICT
• Orthopaedics
• Anticipatory care planning
• Treatment escalation plans
• Palliative care
• Advance care planning

Acknowledgements

SPICT 2019 is used with permission from the SPICT International Programme www.spict.org.uk. Thanks to Professor Gavin Perkins (Director of Clinical Trials Unit, Warwick University) for permission to use results from the June 2018 audit of ReSPECT use run by Warwick University.