P-89 Introduction of ReSPECT to facilitate emergency care planning in the oncology department at bradford teaching hospitals foundation trust

Background

ReSPECT is a national document which aims to summarise advance care planning (ACP) discussions and was introduced to Bradford Teaching Hospitals Foundation Trust (BTHFT) in October 2020. The Oncology team at BTHFT have an inpatient bed base and routinely undertake ACP discussions. We undertook a QIP with the aim of increasing the percentage of patients admitted under Oncology who had documented ACP discussions using a ReSPECT form during their inpatient stay.

Method

Baseline data was collected retrospectively for an 8-week period. Patients who were admitted or who were discharged/died were identified using the ward diary. Data was extracted from the electronic patient record, anonymised and an excel proforma completed. Following baseline data collection and discussion with key stakeholders, interventions were undertaken, including developing a teaching session for oncology juniors and updating the electronic handover form to include ACP information. These changes were implemented and evaluated over a subsequent 27-week period using QI methodology.

Results

In our baseline collection data 19.6% of acute oncology admissions to BTHFT had a ReSPECT form completed prior to death/discharge (n=56). This increased during cycle 1 (n=72) to 23.6% and during cycle 2 (n=116) to 34.5%. Data was plotted using a run chart each week and demonstrated a shift: from weeks 7–13 the percentage of patients who died/were discharged with a ReSPECT form was below the median of 21.1% (7 data points) whereas from weeks 27–32 the percentage was above the median of 21.1% (6 data points).

Conclusion

Our QIP demonstrated a positive impact on percentage of patients who had a ReSPECT form completed by time of death/discharge. However, this change was not sustained and further input is required to achieve this. Once this is accomplished it would be beneficial to share with other specialities within the Trust to facilitate improvement at an organisational level.