113 R-E-S-P-E-C-T: A Closed-Loop Audit Increasing the Quality of ReSPECT Documentation in a Tertiary Surgical Centre in the United Kingdom

Abstract Aim Resuscitation Council UK guidelines suggest Recommended Summary Plans for Emergency Care and Treatment (ReSPECT) must be considered for all patients at risk of deterioration or cardiac arrest or who want to have their wishes documented. This quality improvement project aims to evaluate the use of ReSPECT forms in acute general surgical admissions and improve compliance with the ReSPECT process. Method The audit was registered with the local audit department (REF: GENSUR/CA/2023-24/03). Data was collected in the form of random spot-checks, quantitatively and qualitatively evaluating the completion of ReSPECT forms for all patients admitted via the general surgical ‘take’ at a large inner-city hospital. The first intervention was the addition of ReSPECT forms to the surgical admissions proforma. Second-cycle intervention involved educating clinical teams about the importance of ReSPECT completion by delivering a teaching session and producing a novel poster to be displayed in the unit. Results The initial completion rate of accurate ReSPECT forms was 8%, with 30% counter-signed by the responsible consultant. Re-audit following the first intervention showed ReSPECT form completion rate of 27%, with 50% of forms counter-signed by a consultant. Conclusions The addition of ReSPECT forms to the surgical admission proformas is a simple and effective way of increasing compliance. Overall quality of ReSPECT documentation improved with our interventions, however, there remains scope for further improvement and ongoing education of clinical teams is paramount to improving compliance with the ReSPECT process long-term.