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The Collective Trust Game: An Online Group Adaptation of the Trust Game Based on the HoneyComb Paradigm
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Improving resuscitation decisions: a trust-wide initiative
Michael G Fadel1, Krishan Parekh2, Paul Hayden2
1Department of General Surgery, Medway NHS Foundation Trust, Gillingham, UK.
BMJ Open Quality
|December 6, 2018
Summary
Treatment escalation plans (TEPs) improve patient care by ensuring ceiling of care discussions. Revised TEP forms enhanced documentation and reduced inappropriate critical care referrals, improving patient safety.
Area of Science:
- Medical administration
- Patient safety
- Clinical decision-making
Background:
- Treatment escalation plans (TEPs) are crucial for formalizing ceiling of care discussions.
- Medway Foundation Trust implemented TEP forms in September 2016, requiring consultant completion within 24 hours of admission.
Purpose of the Study:
- To assess the effectiveness of TEP forms in improving escalation planning.
- To evaluate the impact of TEP forms on do not attempt cardiopulmonary resuscitation (DNACPR) decision-making.
Main Methods:
- Three plan-do-study-act cycles were conducted over two years.
- The study involved 100 patients across medicine and surgery.
Main Results:
- Initially, TEP forms were found in 66% of patient notes, with 34% completed appropriately.
- A 13% relative improvement in resuscitation decision-making and a 12% reduction in inappropriate critical care referrals were observed.
- Revision of the TEP form and staff education led to improved discussion and documentation.
Conclusions:
- TEPs effectively facilitate ceiling of care discussions and DNACPR considerations.
- Improved TEP completion and staff clarity enhance patient safety and communication.
- A universal, user-friendly TEP form could be feasible across the NHS.
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