Aiming to improve the rate of documented discussions about resuscitation status for care of the elderly inpatients.

Introduction. Discussions about resuscitation provide patients with the opportunity to be involved in highly consequential decisions about the care they receive. Such discussions often occur in response to a clinical deterioration late in the hospital admission or do not happen at all (Parliamentary and Health Service Ombudsman, 2024). This QIP aimed to increase the proportion of care of the elderly (COTE) inpatients at South Tyneside District Hospital with a documented discussion about resuscitation status. 

Method. Three rounds of data (n=31, n=31 and n=75) were collected at a snapshot in time. Between rounds, interventions were carried out including departmental teaching sessions and the use of poster prompts. Data on documented resuscitation discussions and “Do Not Attempt Cardiopulmonary Resuscitation” (DNACPR) orders were collated and reviewed retrospectively.  

Results. Across all rounds of data collection, 63 of 137 (46%) patients had no discussion about resuscitation documented on their medical record; 42% in round 1, 48% in round 2 and 47% in round 3. Of the 115 patients for whom a DNACPR order was felt to have been appropriate, 85 had DNACPR orders documented (74%) and 30 (26%) did not. Of those 30, 22 (73%) had no discussion about resuscitation documented. 51 discussions occurred on the emergency admissions unit (EAU) and were on average 1.2 days into the admission; 28 discussions occurred on a COTE ward and were on average 6.8 days into admission. 

Conclusion. Our interventions did not increase the proportion of COTE inpatients with a documented discussion about resuscitation. Failure to have (and document) discussions about resuscitation status is associated with a failure to document appropriate DNACPR orders. The rate of documented resuscitation discussions decreases markedly after a patient is admitted from the EAU to a COTE ward and are more likely to be much later in the hospital admission.