Development of the Recommended Summary Plan for eEmergency Care and Treatment (ReSPECT)

Hawkes, Claire; Fritz, Zoë; Deas, Gavin; Ahmedzai, Sam H.; Richardson, Alison; Pitcher, David; Spiller, Juliet; Perkins, Gavin D.

doi:10.1016/j.resuscitation.2020.01.003

Cited by 44 publications

(44 citation statements)

References 18 publications

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“…For some health professionals, the AMBER care bundle was perceived to differ little from their current ways of working. Considering the growing number of end of life care-related support aids or tools, for example ReSPECT [ 10 ], a lack of differentiation may be present and problematic, with some staff resisting interventions they believe may replicate existing practices and reflect an unnecessary administrative burden [ 14 ]. Yet most health professionals perceived little administrative burden associated with the AMBER care bundle, with the required documentation considered simple, clear and easy to complete.…”

Section: Discussionmentioning

confidence: 99%

“…Critical to initial and sustained engagement with the intervention was the provision of a ‘champion’ (nurse facilitator) who ensured that health professionals were prompted to consider all components of the intervention and were supported throughout delivery. The importance of a ‘champion’ has been previously emphasised for the successful implementation of integrated end of life pathways within organisations [ 10 , 47 ]. For the AMBER care bundle, the ‘champion’ promoted active engagement, trained new staff members and provided emotional support to health professionals delivering the intervention.…”

Section: Discussionmentioning

confidence: 99%

“…In response, a growing number of interventions, including the Serious Illness Conversation Guide [ 7 , 8 ], the Universal Form of Treatment Options (UFTO) [ 9 ], the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) [ 10 ], and the Psychosocial Assessment and Communication Evaluation (PACE) [ 11 ], among others, have emerged. These interventions have been designed specifically to assist health professionals identify patients whose situations are clinically uncertain and more effectively navigate decision-making [ 10 , 12 , 13 ], communication [ 5 , 7 , 8 ] and care for those approaching the end of life. Broadly, these interventions aim to provide a structured approach to managing complex needs and uncertainty by developing a clearly communicated and documented care and treatment plan, that incorporates escalation or de-escalation decisions [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…A comparative observational mixed-methods study of the AMBER care bundle identified increased frequency of discussions about prognosis between health professionals and patients, and higher awareness of prognosis by patients [ 23 ]. However, despite instances of communication being greater, they were often associated with a lower quality of information being communicated [ 10 ]. Interviews with health professionals in a qualitative study identified that the AMBER care bundle was often utilised as a tool to categorise patients, to change the focus of care delivery and indirectly served a symbolic purpose in influencing behaviours of individuals and teams [ 24 ].…”

Section: Introductionmentioning

confidence: 99%

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Implementation of a complex intervention to improve care for patients whose situations are clinically uncertain in hospital settings: A multi-method study using normalisation process theory

et al. 2020

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Purpose To examine the use of Normalisation Process Theory (NPT) to establish if, and in what ways, the AMBER care bundle can be successfully normalised into acute hospital practice, and to identify necessary modifications to optimise its implementation. Method Multi-method process evaluation embedded within a mixed-method feasibility cluster randomised controlled trial in two district general hospitals in England. Data were collected using (i) focus groups with health professionals (HPs), (ii) semi-structured interviews with patients and/or carers, (iii) non-participant observations of multi-disciplinary team meetings and (iv) patient clinical note review. Thematic analysis and descriptive statistics, with interpretation guided by NPT components (coherence; cognitive participation; collective action; reflexive monitoring). Data triangulated across sources. Results Two focus groups (26 HPs), nine non-participant observations, 12 interviews (two patients, 10 relatives), 29 clinical note reviews were conducted. While coherence was evident, with HPs recognising the value of the AMBER care bundle, cognitive participation and collective action presented challenges. Specifically: (1) HPs were unable and unwilling to operationalise the concept of ‘risk of dying’ intervention eligibility criteria (2) integration relied on a ‘champion’ to drive participation and ensure sustainability; and (3) differing skills and confidence led to variable engagement with difficult conversations with patients and families about, for example, nearness to end of life. Opportunities for reflexive monitoring were not routinely embedded within the intervention. Reflections on the use of the AMBER care bundle from HPs and patients and families, including recommended modifications became evident through this NPT-driven analysis. Conclusion To be successfully normalised, new clinical practices, such as the AMBER care bundle, must be studied within the wider context in which they operate. NPT can be used to the aid identification of practical strategies to assist in normalisation of complex interventions where the focus of care is on clinical uncertainty in acute hospital settings.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Implementation of a complex intervention to improve care for patients whose situations are clinically uncertain in hospital settings: A multi-method study using normalisation process theory

et al. 2020

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“…The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) is an Emergency Care and Treatment Plan (ECTP), developed to integrate Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decisions with discussions about wider goals of care (1,2). ECTPs were designed to address concerns identi ed about the use of standalone DNACPR decisions by contextualising them within broader treatment plans making recommendations for use in future emergency situations.…”

Section: Introductionmentioning

confidence: 99%

General Practitioners’ Experiences of Emergency Care and Treatment Planning in England: A Focus Group Study

Huxley

Eli

Hawkes

et al. 2020

Preprint

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BackgroundEmergency Care and Treatment Plans are recommended for all primary care patients in the United Kingdom who are expected to experience deterioration of their health. The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) was developed to integrate resuscitation decisions with discussions about wider goals of care. It summarises treatment recommendations discussed and agreed between patients and their clinicians for a future emergency situation and was designed to meet the needs of different care settings. Our aim is to explore GPs’ experiences of using ReSPECT and how it transfers across the primary care and secondary care interface.MethodsWe conducted five focus groups with GPs in areas being served by hospitals in England that have implemented ReSPECT. GPs were asked about their experience of ReSPECT, how they initiate ReSPECT-type conversations, and their experiences of ReSPECT-type recommendations being communicated across primary and secondary care. Focus groups were transcribed and analysed using Thematic Analysis. ResultsGPs conceptualise ReSPECT as an end of life planning document, which is best completed in primary care. As an end of life care document, completing ReSPECT is an emotional process and conversations are shaped by what a ‘good death’ is thought to be. ReSPECT recommendations are not always communicated or transferable across care settings. A focus on the patient’s preferences around death, and GPs’ lack of specialist knowledge, could be a barrier to completion of ReSPECT that is transferable to acute settings. ConclusionConceptualising ReSPECT as an end of life care document suggests a difference in how general practitioners understand ReSPECT from its designers. This impacts on the transferability of ReSPECT recommendations to the hospital setting.

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Resuscitation

Welsby¹

2023

The Great Ormond Street Hospital Manual of Children and Young People's Nursing Practices

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Development of the Recommended Summary Plan for eEmergency Care and Treatment (ReSPECT)

Cited by 44 publications

References 18 publications

Implementation of a complex intervention to improve care for patients whose situations are clinically uncertain in hospital settings: A multi-method study using normalisation process theory

Implementation of a complex intervention to improve care for patients whose situations are clinically uncertain in hospital settings: A multi-method study using normalisation process theory

General Practitioners’ Experiences of Emergency Care and Treatment Planning in England: A Focus Group Study

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