Evaluating the Impact of “Needs Review” Resuscitation Status in the Acute Hospital Setting
Abstract
Introduction
National guidance recommends that resuscitation status is reviewed whenever a patient’s clinical circumstances change, including on readmission. At The Royal Free NHS Foundation Trust, if patients with previous Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions are re-admitted, they are considered to be “for resuscitation” thus they need to be reassessed on readmission. The Trust wished to encourage early review for people with previous DNACPR status, so as part of a re-design of the electronic process for DNACPR and treatment escalation plan (TEP), the Trust introduced a new status on 25th February 2025: “for resuscitation – NEEDS REVIEW” for patients with previous DNACPR decisions. Once reviewed, this status changes to either “for resuscitation” or “DNACPR” and, if “DNACPR”, TEP is mandated at the same time.
Method
This retrospective observational study looked at adult patients admitted to two Older People’s Medicine wards before (November 2024) and after (November 2025) the implementation of the “for resuscitation – NEEDS REVIEW” status. Electronic patient records were reviewed to compare time from admission to DNACPR decision, DNACPR status at discharge, and reinstatement of previous DNACPR decisions between the two groups.
Results
A total of 264 patients were included. Following this intervention, there was an increase in the proportion of patients discharged with a DNACPR decision from 61.7% to 71.8%, a reduction in mean time to DNACPR decision from 51.6 to 47.0 hours (or 35.0 to 27.2 hours in patients with a prior DNACPR decisions), and a decrease in the proportion of previous DNACPR decisions not reinstated during admission from 5.2% to 1.8%.
Conclusion
The introduction of the “for resuscitation – NEEDS REVIEW” status was associated with more prompt DNACPR decision-making, more patients having previous decisions reinstated, and increased DNACPR documentation at discharge. This electronic prompt showed promising results for more timely, consistent resuscitation discussions during acute hospital admission.
Comments
A simple flag that does real work
Thank you, this is a clever piece of electronic design and the drop in previous decisions not reinstated from 5.2% to 1.8% is worthwhile. We are in a ReSPECT region and the lapse on readmission is familiar to us locally. Did the resuscitation status have any effect on treatment escalation plan quality, as opposed to completion, and have you looked at whether the earlier decisions changed where people died?