The Impact of ReSPECT: Improving the quality of advance care planning in frail individuals in secondary care

Introduction: Advance care planning (ACP) supports individuals to express their values and goals regarding future care, playing a crucial role in patient-centred approach. The Gold Standard Framework (GSF) recommends offering ACP to those with declining health, functional deterioration, or major health transitions. Prior to this project, Harrogate District Foundation Trust (HDFT) had not evaluated ACP quality for >2 years, relying solely on DNACPR forms and patient notes.  This QIP assessed the impact of implementing the nationally recommended ReSPECT documentation on ACP quality.

Objective:
To evaluate the extent of ACP in frail patients at HDFT and evaluate whether ReSPECT documentation improved these discussions.

Methods:
In cycle 1, a retrospective review of patient notes from June-December 2023 was conducted to assess the depth of ACP, including DNACPR decisions, treatment ceilings, readmission plans and preferences for place of death and care. The Supportive Palliative Indicator Care Tool (SPICT) identified patients suitable for ACP, with those scoring ≥3 (1 point/life-limiting category) classified as most vulnerable. Cycle 2 followed the implementation of ReSPECT documentation in January 2024 and the quality of ACP was reassessed.

Results:
In Cycle 1, only 11% of SPICT-appropriate patients had ACP beyond resuscitation and treatment ceilings, leaving an 89% opportunity for improvement. After ReSPECT implementation, there was an almost 4-fold increase (41%) in more comprehensive ACP.

Conclusion:
The introduction of ReSPECT significantly improved the depth of ACP. However, further improvement is needed. Next steps include implementing a communication skills workshop to enhance healthcare professionals’ confidence in facilitating ACP discussions.