Abstract
INTRODUCTION
A treatment escalation plan (TEP) should be established for patients at risk of clinical deterioration, particularly when the risks or benefits of specific therapies are uncertain. This plan should be formulated considering inputs from both the patient and their family (SIGN 167). In hospital-at-home setting, TEP was not routinely completed during admission, leading to unclear anticipatory care plans. However, after emphasizing the importance of TEP, we observed significant improvements that positively impacted patient care.
METHODS
Over the course of a month, we collected data focusing on specific TEP-related parameters, without exclusively concentrating on cardiopulmonary resuscitation status (SIGN 167). We highlighted the importance of TEP through ward teachings and integrated its monitoring into our weekly ward round discussions. Additionally, TEP was included in discharge letters.
RESULTS
Initially, our analysis showed that only 7% of patients had TEP completed upon admission, leaving many discharged without clear future treatment plans. A year later, data collection from the same month indicated that 97% of patients had TEP documentation completed on admission, often finalized the same day. This led to clearer care plans for clinical staff, while patients and families gained a better understanding of their preferences in case of deterioration.
CONCLUSION
Standardizing TEP has fostered proactive discussions about ceilings of care for older adults, reducing the need for acute hospital admissions during deterioration and avoiding non-beneficial treatments. By emphasizing timely planning and recognition of acute deterioration, we acknowledge that many patients with life-limiting illnesses prioritize symptom palliation over disease recovery.