Improving the Quality of ReSPECT Documentation in Older Adults Admitted to an Acute Medical Unit: A Quality Improvement Audit

Abstract Content :

Background

The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process promotes personalised emergency care planning and shared decision-making for patients at risk of clinical deterioration. High-quality documentation is essential to ensure appropriate escalation decisions and patient-centred care. This audit evaluated compliance with Resuscitation Council UK (RCUK) standards for ReSPECT documentation in an Acute Medical Unit (AMU).

Methods

A retrospective audit of 50 consecutive patients admitted to the AMU between 1–15 April 2026 was undertaken. Patients were included if they were aged ≥65 years, had significant frailty (Clinical Frailty Scale >5), multiple comorbidities, or evidence of clinical deterioration. ReSPECT forms and electronic records were reviewed against RCUK standards, including documentation of DNACPR decisions, ceiling of care, mental capacity assessment, patient/family involvement, senior clinician review, and timeliness of completion.

Results

Compliance with documentation standards was variable and below the target standard of 100%. DNACPR decisions and ceilings of care were documented in 72% of cases. Mental capacity assessments were recorded in 69% and senior clinician involvement in 62%. Evidence of patient or family discussion was present in 69.4% of records, while 30.6% lacked documentation of shared decision-making. Only 60% of ReSPECT forms were completed within 24 hours of admission. Deficiencies were most apparent in timely completion, senior review, and documentation of patient-centred discussions.

Conclusion

Significant gaps exist in ReSPECT documentation within our AMU, particularly regarding senior clinician involvement and shared decision-making. These findings highlight opportunities to improve advance care planning and escalation decision-making. Targeted educational interventions, consultant engagement, and structured documentation prompts have been introduced. A re-audit is planned to assess the effectiveness of these interventions and drive sustained improvement in patient-centred care