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Clinical audit
Advance care and resuscitation plans in a tertiary hospital: a multimodal approach
  1. Sarika Suresh1,
  2. Angela Au1,
  3. Sharanya Mohan1,
  4. Johnny Huang1,
  5. Christiana Guthrie1,
  6. Jessica Tsuann Lee1,2,3,4 and
  7. Ghauri Aggarwal2,5,6
  1. 1 Concord Repatriation General Hospital, Concord, New South Wales, Australia
  2. 2 Concord Centre for Palliative Care, Sydney, NSW, Australia
  3. 3 IMPACCT, University of Technology Sydney, Sydney, NSW, Australia
  4. 4 Concord Clinical School, University of Sydney, Sydney, NSW, Australia
  5. 5 Concord Hospital, Sydney, NSW, Australia
  6. 6 Department of Medicine, University of Sydney, Sydney, NSW, Australia
  1. Correspondence to Dr Jessica Tsuann Lee; jessica.lee1{at}health.nsw.gov.au

Abstract

Objectives Advance care planning (ACP) is the process of documenting a person’s preference for medical treatment in the event of future deterioration. This audit aimed to improve discussion and documentation of ACP in patients who die during a hospital admission.

Methods We performed a clinical audit in 2021 of inpatients at a tertiary hospital in Sydney, Australia to evaluate the benefit of multimodal interventions to improve ACP compared with previous audits from 2016 and 2011.

Results In 2021, 97% of audited patients had a documented ACP prior to death compared with 80% in the 2016 audit. The completion of NFR documentation on admission in 2016 was 33%, while in 2021 65% of ACPs were completed within 24 hours of admission.

In 2021, 94% of patients had a paper resuscitation form filled; however, identification stickers, which are associated with risk of error, were used in 64%; and 25% of forms were only partially completed. Palliative care was consulted for 44% of patients prior to death; 33% on the day of or prior to death.

Conclusions Improvement in prevalence and timing of ACP prior to death is seen in the postintervention audit. A repeat audit in 5 years will be conducted, with interventions focused on improving documentation of ACP.

  • Advance Care Planning
  • Hospital care
  • Advance Directives
  • Education and training

https://doi.org/10.1136/spcare-2023-004476

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    Footnotes

    • Contributors SS: conception and design, analysis and interpretation of data, drafting and revising article. AA: conception and design, analysis and interpretation of data, drafting and revising article. SM: data collection, analysis and interpretation of data. JH: data collection, analysis and interpretation of data. CG: conception and design. JTL: conception and design, drafting and revising article, supervison of project. GA: conception and design, drafting and revising article, supervision of project

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.