Background Average life expectancy for UK care home residents is 24 months, or 12 for those with nursing care. This population have higher ED attendance than the general population of the same age. DNAR and ReSPECT documents allow communication of plans for future emergencies, with ReSPECT incorporating both personal preference and professional judgement. This study explores the use of these documents in a single ED.

Methods Residents attending UHNM ED in a week in October 2020 or February 2021 were followed up for 2 months. UHNM discontinued DNAR with preference for ReSPECT documents between these timepoints. Data was retrospectively collected from electronic records regarding demographics; prior establishment, acknowledgement or implementation of either document on attending ED; attendances either side of the event and; death, if applicable.

Results Data of 74 patients from October and 51 patients from February were analysed with mean age of 85.6 and 86 years respectively. Residents of both cohorts averaged 2.2 ED attendances during the year prior to the event.

In October 64% (47) of residents had DNAR and 6.8% (5) ReSPECT documents with further implementation of ReSPECT in 2.9% (2). Of those with a ReSPECT 71% (5) were admitted, compared to 63% (42) of those without. 28% (21) of patients died during follow-up.

In February 69% (35) of patients had DNAR and 17.6% (9) ReSPECT documents with further implementation of ReSPECT in 7.1% (3). Of those with a ReSPECT 42% (5) were admitted, compared to 72% (28) of those without. 14% (7) of patients died during follow-up.

Conclusion The data demonstrates that greater uptake of ReSPECT documents for care home residents could lead to reduced hospital admissions for those attending ED. Further consideration is required to understand how to improve implementation, in order to be able to respect patient’s wishes in an emergency.