MTP7.17 An audit project on the completion of treatment escalation plan (TEP) for surgical patients for decisions about the ceiling of care in a tertiary care major NHS trauma

Aims The objective of this project is to evaluate the number of acute and elective surgical patients with variable frailty (Rockwood) score admitted on the surgical floor with or without documented ceiling of care in the form of a treatment escalation plan (TEP) form. Methods A closed loop audit was performed after getting approval from the local R & D department. Data was collected from the patient case notes. The results of the first loop of the audit project were discussed in the departmental clinical governance meeting in the presence of the frailty consultant. After getting recommendations, data for the second loop of the project was collected. Results The case notes of seventy-eight consecutive acute and elective surgical admissions were reviewed in the first loop of the audit. The first loop of the audit cycle yielded only 58 % (45/78) of surgical patients who had a documented ceiling of care in the form of a completed TEP form. After the implementation of the recommendations and regular reviews of patients with variable frailty scores by the frailty consultant, the documentation and decisions about the ceiling of care improved to 83 % (65 patients out of a total of 78 patients recruited in the second loop of the audit). Conclusion Decisions about the ceiling of care in the form of completed TEP proforma in surgical admissions provide greater autonomy to the patients, relatives, and help the surgical doctors to determine the ceiling of care, especially out of hours. Current audit project demonstrates improved compliance in the second cycle.