Aims

To evaluate, in UK acute hospitals, the early implementation of the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT), which embeds cardiopulmonary resuscitation (CPR) recommendations within wider emergency treatment plans. To understand for whom and how the process was being used and the quality of form completion.

Methods

A retrospective observational study evaluating emergency care and treatment planning approaches used in acute UK hospitals (2015–2019), and in six English hospital trusts the extent of ReSPECT use, patient characteristics and completion quality in a sample 3000 patient case notes.

Results

The use of stand-alone Do Not Attempt Cardiopulmonary Resuscitation forms fell from 133/186 hospitals in 2015 to 64/186 in 2019 (a 38% absolute reduction). ReSPECT accounted for 52% (36/69) of changes.

In the six sites, ReSPECT was used for approximately 20% of patients (range 6%-41%). They tended to be older, to have had an emergency medical admission, to have cognitive impairment and a lower predicted 10 year survival. Most (653/706 (92%)) included a ‘not for attempted resuscitation’ recommendation 551/706 (78%) had at least one other treatment recommendation. Capacity was not recorded on 13% (95/706) of forms; 11% (79/706) did not record patient/family involvement.

Conclusions

ReSPECT use accounts for 52% of the change, observed between 2015 and 2019, from using standalone DNACPR forms to approaches embedding DNACPR decisions within in wider emergency care plans in NHS hospitals in the UK. Whilst recommendations include other emergencies most still tend to focus on recommendations relating to CPR. Completion of ReSPECT forms requires improvement.

Study registration: https://www.isrctn.com/ISRCTN11112933

中文翻译：

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ReSPECT 在急性医院的实施：一项回顾性观察研究

目标

在英国急诊医院评估急诊护理和治疗推荐总结计划 (ReSPECT) 的早期实施情况，该计划将心肺复苏 (CPR) 建议嵌入到更广泛的急诊治疗计划中。了解该流程的使用对象和方式以及表格完成的质量。

方法

一项回顾性观察研究评估了英国急性医院（2015-2019 年）和六家英国医院使用的紧急护理和治疗计划方法，相信在 3000 例患者病例记录样本中 ReSPECT 的使用程度、患者特征和完成质量。

结果

独立的“请勿尝试心肺复苏”表格的使用从 2015 年的 133/186 家医院下降到 2019 年的 64/186 家（绝对减少 38%）。尊重占变化的 52% (36/69)。

在六个地点，ReSPECT 用于大约 20% 的患者（范围 6%-41%）。他们往往年龄较大，接受过紧急医疗入院，有认知障碍和较低的预计 10 年生存率。大多数 (653/706 (92%)) 包括“不用于尝试复苏”的建议 551/706 (78%) 至少有一项其他治疗建议。13% (95/706) 的表格没有记录容量；11% (79/706) 没有记录患者/家庭参与。

结论

在 2015 年至 2019 年间观察到的变化中，ReSPECT 的使用占了 52%，从使用独立的 DNACPR 表格到将 DNACPR 决策嵌入到英国 NHS 医院更广泛的急救计划中。虽然建议包括其他紧急情况，但大多数仍倾向于关注与 CPR 有关的建议。完成 ReSPECT 表格需要改进。

研究注册： https ://www.isrctn.com/ISRCTN11112933