TY - JOUR
T1 - Implementation of ReSPECT in acute hospitals
T2 - A retrospective observational study
AU - Hawkes, Claire A
AU - Griffin, James
AU - Eli, Karin
AU - Griffiths, Frances
AU - Slowther, Anne-Marie
AU - Fritz, Zoë
AU - Underwood, Martin
AU - Baldock, Catherine
AU - Gould, Doug
AU - Lilford, Richard
AU - Jacques, Claire
AU - Warwick, Jane
AU - Perkins, Gavin D
N1 - Funding Information:
GDP is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands.
Funding Information:
This study was funded by the UK National Institute for Health Research (NIHR) under the Health and Social Care Delivery Research programme (project number 15/15/09 ). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.
Funding Information:
We would like to thank the following for their valuable contributions to and advice about the study; the Public and Patient Involvement members of the research, team, advisory group and the steering committee, other members of the steering committing, the site research teams, principal investigators and Warwick clinical Trials study research team. This study was funded by the UK National Institute for Health Research (NIHR) under the Health and Social Care Delivery Research programme (project number 15/15/09). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The study sponsor, the University of Warwick, was not involved in the study design, the collection, analysis and interpretation of data, the writing of the manuscript and in the decision to submit the manuscript for publication. GDP is supported by the National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands. All data requests should be submitted to the study's chief investigator, for consideration. Access to anonymised data may be granted following review.
Publisher Copyright:
© 2022
PY - 2022/9/1
Y1 - 2022/9/1
N2 - AIMS: To evaluate, in UK acute hospitals, the early implementation of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT), which embeds cardiopulmonary resuscitation (CPR) recommendations within wider emergency treatment plans. To understand for whom and how the process was being used and the quality of form completion.METHODS: A retrospective observational study evaluating emergency care and treatment planning approaches used in acute UK hospitals (2015-2019), and in six English hospital trusts the extent of ReSPECT use, patient characteristics and completion quality in a sample 3000 patient case notes.RESULTS: The use of stand-alone Do Not Attempt Cardiopulmonary Resuscitation forms fell from 133/186 hospitals in 2015 to 64/186 in 2019 (a 38% absolute reduction). ReSPECT accounted for 52% (36/69) of changes. In the six sites, ReSPECT was used for approximately 20% of patients (range 6%-41%). They tended to be older, to have had an emergency medical admission, to have cognitive impairment and a lower predicted 10 year survival. Most (653/706 (92%)) included a 'not for attempted resuscitation' recommendation 551/706 (78%) had at least one other treatment recommendation. Capacity was not recorded on 13% (95/706) of forms; 11% (79/706) did not record patient/family involvement.CONCLUSIONS: ReSPECT use accounts for 52% of the change, observed between 2015 and 2019, from using standalone DNACPR forms to approaches embedding DNACPR decisions within in wider emergency care plans in NHS hospitals in the UK. Whilst recommendations include other emergencies most still tend to focus on recommendations relating to CPR. Completion of ReSPECT forms requires improvement.STUDY REGISTRATION: https://www.isrctn.com/ISRCTN11112933.
AB - AIMS: To evaluate, in UK acute hospitals, the early implementation of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT), which embeds cardiopulmonary resuscitation (CPR) recommendations within wider emergency treatment plans. To understand for whom and how the process was being used and the quality of form completion.METHODS: A retrospective observational study evaluating emergency care and treatment planning approaches used in acute UK hospitals (2015-2019), and in six English hospital trusts the extent of ReSPECT use, patient characteristics and completion quality in a sample 3000 patient case notes.RESULTS: The use of stand-alone Do Not Attempt Cardiopulmonary Resuscitation forms fell from 133/186 hospitals in 2015 to 64/186 in 2019 (a 38% absolute reduction). ReSPECT accounted for 52% (36/69) of changes. In the six sites, ReSPECT was used for approximately 20% of patients (range 6%-41%). They tended to be older, to have had an emergency medical admission, to have cognitive impairment and a lower predicted 10 year survival. Most (653/706 (92%)) included a 'not for attempted resuscitation' recommendation 551/706 (78%) had at least one other treatment recommendation. Capacity was not recorded on 13% (95/706) of forms; 11% (79/706) did not record patient/family involvement.CONCLUSIONS: ReSPECT use accounts for 52% of the change, observed between 2015 and 2019, from using standalone DNACPR forms to approaches embedding DNACPR decisions within in wider emergency care plans in NHS hospitals in the UK. Whilst recommendations include other emergencies most still tend to focus on recommendations relating to CPR. Completion of ReSPECT forms requires improvement.STUDY REGISTRATION: https://www.isrctn.com/ISRCTN11112933.
UR - http://www.scopus.com/inward/record.url?scp=85134774056&partnerID=8YFLogxK
U2 - 10.1016/j.resuscitation.2022.06.020
DO - 10.1016/j.resuscitation.2022.06.020
M3 - Article
C2 - 35779800
SN - 0300-9572
VL - 178
SP - 26
EP - 35
JO - Resuscitation
JF - Resuscitation
ER -