Emergency care treatment escalation plans Other Emergency care treatment escalation plans
Conditions
Interventions
This study evaluates the ReSPECT process, it is therefore not an intervention but rather an evaluation of a process already in place. The evaluation is conducted across four work packages with a mixed
Sponsors
University of Warwick
Heart of England NHS Foundation Trust
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: WP1a: 1. Adult in-patients involved in discussions for the ReSPECT process 2. Relatives of adult patients without capacity, involved in discussions for the ReSPECT process 3. Clinicians completing the ReSPECT process WP2: Anonymised patient audit data from National Cardiac Arrest Audit (NCAA) from all participating UK hospitals WP3: Adult in-patients in the 6 NHS trust hospitals recruited WP4: 1. GPs working in practices served by the 6 NHS trust Sites in WP1 and WP3 2. NHS trust staff and members of the National Working Group that developed ReSPECT attending meetings to share experiences of implementing ReSPECT
Exclusion criteria
Exclusion criteria: WP1: 1. Adult in-patients without a ReSPECT form 2. Neonates, pediatric, day case patients and others refusing consent (WP1a) or who opt-out (WP1b) 3. Clinicians not involved in completing ReSPECT forms WP2: N/A WP3: Paediatrics, Neonates, day case admissions, patients who opt-out WP4: GPs from practices not serving the 6 NHS Trust sites in WP1 and WP3
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The study design is a mixed methods evaluation consisting of qualitative and quantitative methods. WP1 and WP4 use qualitative methods; therefore, they do not have a primary outcome measure. WP2: Number of resuscitation attempts that are terminated due to futility is measured using the National Cardiac Arrest Audit Dataset at point of data analysis WP3: 1. Pressure ulcers is measured using the NHS Classic Safety Thermometer Audit Dataset at point of data collection on specified day 2. Urine infections in catheterised patients is measured using the NHS Classic Safety Thermometer Audit Dataset at point of data collection on specified day 3. Falls is measured using the NHS Classic Safety Thermometer Audit Dataset at point of data collection on specified day 4. Venous thromboembolism is measured using the NHS Classic Safety Thermometer Audit Dataset at point of data collection on specified day 5. Drug induced harm is measured using the NHS Medication Safety Thermometer Audit Dataset at point of data collection on specified day | — |
Secondary
| Measure | Time frame |
|---|---|
| WP2: 1. Number of in-hospital cardiac arrests attended by the resuscitation team per one thousand admissions is measured using National Cardiac Arrest Audit Dataset at point of data analysis 2. Patient status at team arrival (dead – resuscitation stopped; resuscitation on-going; ROSC achieved before team arrival; deteriorating (not yet arrested) is measured using National Cardiac Arrest Audit Dataset at point of data analysis 3. Proportion of resuscitation attempts that are terminated due to presence of a DNACPR (this represents a failure of implementation) are measured using National Cardiac Arrest Audit Dataset at point of data analysis 4. Vital status at hospital discharge (alive or dead) is measured using the National Cardiac Arrest Audit Dataset at point of data analysis 5. Proportion of shockable arrhythmic cardiac arrests is measured using the National Cardiac Arrest Audit Dataset at point of data analysis 6. Cerebral Performance Category at discharge is measured using the National Cardiac Arrest Audit Dataset at point of data analysis WP3: 1. Demographics (age, gender, ethnicity, abbreviated home postcode as a proxy for social class) are measured using patient notes at point of data collection on specified day 2. Reason for admission is measured using patient notes at point of data collection on specified day 3. Co-morbidities: Cognitive impairment (dementia, learning difficulties), Charlson co-morbidity index, GO-FAR sore (both of which predict outcome from cardiac arrest), assessment of whether their condition is likely to be fatal is measured by McCabe Scale at point of data collection on specified day 4. ReSPECT (patient preference, emergency care treatment decisions, resuscitation status, capacity, who was involved in the discussions, when, where and by whom was the decision made) is measured using patient notes at point of data collection on specified day 5. NHS Safety Thermometer Audit data at point of data collection on specified day 6. Length o | — |
Countries
England, United Kingdom
Contacts
Public ContactClaire Jacques
Outcome results
None listed