Use of resuscitation plans at a tertiary Australian hospital: room for improvement

Smith, Roger; Santamaria, John; Holmes, Jennifer; Faraone, Espedito E; Hurune, Patricia N.; Reid, David A.

doi:10.1111/imj.13460

Cited by 6 publications

(13 citation statements)

References 14 publications

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“…1 Structured similarly to the GOC form, and with more data available for review, the Acute Resuscitation Plan (ARP) form showed a rate of completion upwards of 60% in a subgroup of general medicine patients in a 2017 Australian study. 8 Of note this study showed only 37% of overall inpatient ARP forms reviewed noted discussion with the patient or patient's representative. Therefore, there are concerns that the implementation of GOC forms may face similar challenges.…”

Section: Introductionmentioning

confidence: 81%

Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Potenzi

Lim

2020

Internal Medicine Journal

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Background: The goals-of-care (GOC) form is a resuscitation planning tool used to document informed decisions tailored for individual patients admitted to hospital. Proper and timely completion of the GOC form is essential for its effective utility. Aims: To identify patient factors which may affect the timely discussion and documentation of GOC forms in patients admitted under a general medicine unit. Methods: We performed a cross-sectional study of 2589 patients during 3093 admissions under the general medicine unit from January 2017 to July 2017 at Dandenong Hospital in Melbourne, Australia. The main outcome was the proper completion of GOC forms, defined as GOC completion within 48 h of admission and adequate discussion with the patient or substitute decision maker. We used logistic regression to determine the association between the main outcome and several patient-related independent variables. Results: A GOC form was completed in 66% of all admissions but only 35% were considered properly completed (timely and adequately discussed). In the general multivariable logistic regression model, the variables associated with proper completion of GOC forms were age (OR = 1.58), English as the main spoken language (OR = 1.43) and readmissions (OR = 1.27). In patients 75 years and older, additional factors associated with proper GOC completion were confusion on admission (OR = 1.31) and number of comorbidities (OR = 1.27). Conclusions: The proper GOC form completion rates were suboptimal in general medicine admissions, particularly in younger patients with fewer comorbidities. Additional effort is needed to improve GOC completion in these patients and those whose primary spoken language is not English.

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Section: Introductionmentioning

confidence: 81%

Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Potenzi

Lim

2020

Internal Medicine Journal

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“…This revealed that 75.4% of admissions to the GEM unit had at least one ARP during their time on the ward. This is significantly higher than the rate of ARP documentation in the acute wards of SVHM, at 7.5%, and it is higher than the SVHM acute general medical units whose completion rate was 63.6% . This is not surprising as the priorities of acute management are diagnostic and therapeutic, and patients often have a shorter length of stay.…”

Section: Discussionmentioning

confidence: 80%

“…The PAS interrogation also provided routinely collected data, including patient demographics, treating consultant and functional independence measure (FIM) on admission and separation. Additionally, using a previously published method, Charlson comorbidities and a Charlson index of comorbidity (IOC) were determined for each inpatient episode from separation diagnoses. Each admission episode's scanned medical record was reviewed, and the presence, number and completion of ARPs (see Appendix ) prior to separation were recorded on an audit sheet (see Appendix ).…”

Section: Methodsmentioning

confidence: 99%

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Resuscitation planning on a subacute geriatric evaluation and management ward

et al. 2019

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Objectives To describe the use of acute resuscitation plans (ARPs) among patients on a subacute geriatric ward and to identify factors associated with use of ARPs in these patients. Methods The hospital records of all patients admitted to the geriatric medicine ward in 2016 were retrospectively audited. Results An ARP was completed before separation for 333/442 (75.3%) admissions. In the event of arrest, 240 (54.3%) patients had an ARP specifying “care of the dying”, 93 (21.0%) had an ARP specifying “cardiopulmonary resuscitation” and 109 (24.7%) had no resuscitation plan. Age 85‐94 years (OR 1.65, P = 0.04) and ≥95 years (OR 9.59, P = 0.003), as well as Charlson index of comorbidity ≥2 (OR 3.4, P < 0.001), Australian‐born (OR 2.09, P = 0.002) and admission during October‐December (OR 3.81, P < 0.001) were independently associated with increased use of ARPs. Conclusions Acute resuscitation plan use was associated with older age, higher comorbidity, birth in Australia and admission later in the year.

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“…The treatment limitation form, designed to be completed after consideration of the patient’s individual circumstances as an official record of the outcome of the team’s informed decision-making, 21 was instead used by some participants as a way of knowing when a patient was deteriorating or dying. Similarly, in the absence of other indicators, the commencement of a dying care pathway was also used as a signal that a patient was dying.…”

Section: Discussionmentioning

confidence: 99%

Communicating end-of-life care goals and decision-making among a multidisciplinary geriatric inpatient rehabilitation team: A qualitative descriptive study

et al. 2018

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Background:In geriatric inpatient rehabilitation settings, where the goal is to optimise function, providing end-of-life care can be challenging.Aim:The aim of this study is to explore how end-of-life care goals and decision-making are communicated in a geriatric inpatient rehabilitation setting.Design:The design is a qualitative descriptive design using semi-structured individual and group interviews.Setting/participants:This study was conducted in a 154-bed facility in metropolitan Melbourne, Australia, providing geriatric inpatient rehabilitation for older patients; medical, nursing and allied health clinicians, who had cared for an inpatient who died, were recruited.Data collection:Participants were interviewed using a conversational approach, guided by an ‘aide memoire’.Results:A total of 19 clinicians participated in this study, with 12 interviewed individually and the remaining 7 clinicians participating in group interviews. The typical patient was described as older, frail and with complex needs. Clinicians described the challenge of identifying patients who were deteriorating towards death, with some relying on others to inform them. How patient deterioration and decision-making was communicated among the team varied. Communication with the patient/family about dying was expected but did not always occur, nor was it always documented. Some clinicians relied on documentation, such as commencement of a dying care pathway to indicate when a patient was dying.Conclusion:Clinicians reported difficulties recognising patient deterioration towards death. Uncertainty and inconsistent communication among clinicians about patient deterioration negatively impacted team understanding, decision-making, and patient and family communication. Further education for all members of the multidisciplinary team focusing on how to recognise and communicate impending death will aid multidisciplinary teams to provide quality end-of-life care when required.

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Use of resuscitation plans at a tertiary Australian hospital: room for improvement

Abstract: More patients had resuscitation plans after introducing the ARP. However, patients and senior physicians were often remote from the consultation process, and an ARP was not present for many patients likely to have a poor outcome from cardiopulmonary arrest.

Cited by 6 publications

References 14 publications

Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Resuscitation planning on a subacute geriatric evaluation and management ward

Communicating end-of-life care goals and decision-making among a multidisciplinary geriatric inpatient rehabilitation team: A qualitative descriptive study

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