WTP2.08 Ceiling of care and escalation pathway decision making in general surgical patients at a busy tertiary care centre in NHS

Aim South Tees Trust resuscitation guidelines (on intranet) suggest that escalation plan for all the patients must be completed within 24 hours of the admission. Primary aim of this audit is to assess compliance to local trust-guidelines in the general surgery department. Secondary aim is to identify the median age group and co-morbidities score (Charlson Comorbidity Index) of the patients for ward-based ceiling of care. Methods Registered as an audit with the Clinical Audit team at JCHU with an id of 1832. Retrospective data collection. 97 patients included. Variables collected include patient number, age, sex, date of admission, date of discharge, LOS, ceiling of care discussion and date, date of DNACPR, DNACPR in community, DNACPR-in-hospital. Statistics done on Ststsdirect3 software. Results We had 9 out of 10 patients who were put on ward-based level of care expiring. In 7 out of the 9 cases, ITU escalation was done during night shifts and ceiling of care decision had to be taken-overnight. Median age for DNACPR and ward-based ceiling of care in surgical patients is 74 years and median CCI score is 9. 6 patients had documented ceiling of care on the day of admission or within 24 hours making the adherence of 6.18%. Email will be sent to all the doctors of the surgical team regarding the documentation of ceiling of care in electronic-notes at admission or on post take ward rounds and reaudit in 2 months-time.