Boosting Advance Care Planning for Elderly Surgical Patients: Filtering out errors

Boosting Advance Care Planning for Elderly Surgical Patients: Filtering out errors

Introduction:

The ReSPECT form documents a patient’s preferences regarding care, religious wishes, preferred place of care/death and the ceiling of care within hospital settings. Although clinical recommendations often align with patient preferences, only around half of ReSPECT plans accurately record these personal wishes. Our goal was to improve compliance and quality in documenting ReSPECT forms for elderly patients admitted to general surgery at Bradford Royal Infirmary, which would lead to better patient-centred care and reduced potential harm.

Method:

We reviewed patients aged >77 years, admitted to the Surgical Assessment Unit and general surgical ward via the Emergency Department between September and November 2025. Screening determined whether patients had an existing ReSPECT or advance care plan (ACP) and if these were updated within 48 hours of admission. Information was gathered from the Electronic Patient Record (EPR), noting patient age, Clinical Frailty Score, ReSPECT plan presence, and DNACPR status. Plans that already existed from previous admissions or community records were identified manually through historical notes and GP documentation.

An intervention between data collection cycles introduced an electronic notes filter within EPR to highlight ReSPECT and DNACPR entries instantly. Resident doctors were trained to use the filter and instructed on the essential elements required for updating ReSPECT forms and engaging patients in discussions.

Results:

The first cycle included 19 patients; 32% (n=6) had existing ReSPECT plans or DNACPR orders, with 50% (n=3) updated within 48 hours. In the second cycle, 13 patients were reviewed; 46% (n=6) had existing plans, and all were updated promptly, achieving 100% compliance.

Conclusion:

Implementing an EPR filter and providing targeted training significantly improved timely documentation of ReSPECT plans and DNACPR status, increasing update rates from 50% to 100% across the two audit cycles.