1 Does your patient have a treatment escalation plan? Think, discuss, document, validate

IntroductionEvidence suggests that healthcare professionals are poor at initiating discussions with patients about treatment escalation plans (TEP), despite most patients wishing to be involved in this. Patients are often subject to futile resuscitation attempts or distressing investigations and treatment while doctors on-call struggle with hurried decisions in acute settings.AimTo improve documentation of treatment escalation plans for medical patients in the Acute Assessment Unit (AAU) at a district general hospital in London.MethodsLeadership, communication and awareness of staff was identified as primary drivers for this project. Utilising Quality Improvement (QI) methodology, we ran Plan-Do-Study-Act (PDSA) cycles for each of our interventions.We utilised the local Morbidity and Mortality meetings to highlight the importance of advanced care planning. During Covid simulation sessions in the pandemic, we placed strong emphasis on discussing TEP for acute admissions. Morning board meetings served as a ‘checkpoint’ to identify patients without a TEP. We designed a TEP poster which was displayed in AAU and circulated on social media. Emails were sent to consultants and junior doctors regarding the importance of discussing TEP.We identified improvement by calculating the percentage of AAU patients with a documented TEP which was done by analysing electronic records weekly. We also recorded any inappropriate cardiac arrest calls based on data provided by the resuscitation team.ResultsThis project ran across 49 weeks and included 500 inpatients. The initial documentation rate of TEP was 40% at the start of the project and had risen to 70% by the end of the project.ConclusionsHealthcare professionals should be well supported in decisions surrounding appropriate TEP as this is highly complex. Effective leadership in this regard is crucial to ensure delivery of high-quality patient care.*Presenter