Improving ReSPECT Form Completion in a Urology Department: Findings from a Two-Cycle Audit and Clinician Survey

Background

This project was conducted within the Urology inpatient department at Leicester General Hospital, led by resident doctors under consultant supervision.

Introduction

ReSPECT forms summarise personalised recommendations for a patient’s care in an emergency setting, outlining their priorities and fears. Incomplete ReSPECT forms risk inappropriate interventions that do not align with patients’ wishes or clinical needs. Locally, the completeness and quality of ReSPECT forms varied, with missing patient preferences or unclear escalation plans, contributing to miscommunication between teams. This audit aimed to increase the accuracy and appropriateness of ReSPECT forms across the department.

Method

A two-cycle audit was conducted. ReSPECT forms were analysed for completeness, as well as clarity of escalation plans. For patients aged ≥80 without a form, documentation of ReSPECT consideration was assessed. Following cycle one, targeted teaching and informative guides were introduced. ReSPECT forms and patients ≥80 without a form were subsequently re-audited. After cycle two, a clinician survey exploring barriers to ReSPECT form completion was distributed.

Results

Cycle one showed 12.5% (n=8) of ReSPECT forms were complete, with 50% including clear escalation plans. 17% (n=6) of patients ≥80 without a form had documented consideration. Post-intervention, 20% (n=20) of forms were complete, and 75% detailed appropriate escalation plans, yet documented consideration in patients ≥80 without a form fell to 7% (n=14). Survey responses (n=12) revealed key barriers: forms were deprioritised during busy shifts, and clinicians struggled with discussions when delivering bad news. Improvements in escalation plans were made, decreasing the likelihood of unnecessary interventions. Future work requires regular teaching and modifications to clerking proformas.

Conclusion

Despite interventions, ReSPECT form completion and consideration remained suboptimal, with clinicians facing communication and environmental challenges. Teaching sessions improved awareness but did not overcome communication barriers. Interactive workshops and embedding checklists into ward rounds may better support clinicians and sustain local improvement.