eP587 Ceiling of Care and Escalation Pathway Decision Making in General Surgical Patients at JCUH – Loop Completion

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 and the reaudit is to complete the loop after the recommendations from first cycle have been implemented. Inclusion – all patients admitted under the department of general surgery at James Cook University Hospital from the emergency department from 1 Jan 2025 to 22 Jan 2025. Methods Registered as an audit with the Clinical Audit team at JCHU with an id of 1835. Retrospective data collection from the colorectal and upper GI patient lists. A total of 100 patients included in the study. 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. Intervention – email was sent to all the junior doctors and Consultants in general surgical department, highlighting the findings of first cycle and importance of ceiling of care documentation. Results All the patients placed on ward based level of care died in the hospital. 10 patients with community DNAR did not have documentation of the same in the clerking documents. Conclusion The adherence in 1st cycle was 6.18% and it has come down to 5% in second cycle. We plan to organise teaching session for all the general surgical junior doctors to adhere to the trust guidelines.