Introduction Whilst treatment escalation planning is widely acknowledged as an important aspect of care its clinical application is variable. We set out to audit what proportion of patients referred to a hospital specialist palliative care team (SPCT) had treatment escalation plans in place and of those who did the circumstances of this decision making.
Methods A retrospective audit of 140 patients referred to the SPCT over July 2020. Electronic records examined to establish whether patients had a DNACPR and/or treatment escalation plan (ie written record of whether consideration of escalation to level 2/3 care would be appropriate) in place at time of referral. If a treatment escalation plan was in place records were further examined to evaluate what prompted this decision, who lead the decision making and when it was made.
Results Of the 140 patients audited 65% had a DNACPR in place at time of referral and 46% had a treatment escalation plan in place. Of those who had a treatment escalation plan 35% had this plan made with their treating consultant with others having this plan made with specialty registrars (33%), SHO grade doctors (22%), or other consultants including critical care (7%). Hospital admission prompted planning in the majority of cases (66%). A significant proportion of decisions were made out of hours (47%).
Conclusion Despite all the patients in this cohort having identified, inpatient specialist palliative care needs 64% did not have a treatment escalation plan in place. Of those who did only 35% had made this with their treating consultant and many decisions were made out of hours. This audit shows that we have significant opportunity to improve treatment escalation planning in patients referred to SPCTs. We aim to introduce improved treatment escalation planning in the Trust through education and clearer documentation.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.