Background Do Not Attempt Cardiopulmonary Resuscitation (DNA CPR) orders and Treatment Escalation Plans (TEPs) are key components of advanced care planning for managing patients with progressive life-limiting illnesses and significant frailty. Our study aimed to determine the proportion of such patients being transferred from residential care facilities with documented TEPs upon medical admission, examine whether these TEPs were revised during the hospital stay, and assess patient outcomes at 14 days post-presentation. Methods We reviewed the lists of patients who had been referred for medical admission via the emergency department over a one-month period and identified those presenting from residential care facilities. We excluded those under the age of 65. We reviewed relevant medical notes and collected anonymised data into an Excel spreadsheet on a password protected computer. Results We identified 34 patient’s relevant patients. Notes were available for review in 31 cases (17 male; age range 66 to 96 years old, mean age 82.3). Of the 31 cases reviewed, the mean Clinical Frailty Score was 7.4. Residential care facilities sent documentation outlining TEPs in 19/31 cases. In those cases, 4/19 specified full resuscitation. In 3/4 of these cases, the TEP was revised during their admission. In one case, documentation specified that the patient did not want to be transferred to hospital under any circumstances. A total of 14 patients had no documentation regarding TEP. Of those, 7/14 went on to have DNA CPR orders filled out during their admission. At 14 days post presentation, 7 had died in hospital, 16 were discharged back to their residential care facility, and the remainder remained inpatient. Conclusion These findings underscore the need for better advance care planning, potentially improving patient management and reducing the emotional burden on patients, healthcare providers and families during critical moments.

中文翻译：

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改进高级护理计划：住院护理入院中 DNA CPR 命令和 TEP 的记录


背景 请勿尝试心肺复苏 (DNA CPR) 指令和治疗升级计划 (TEP) 是用于管理患有进行性生命限制疾病和严重虚弱的患者的高级护理计划的关键组成部分。我们的研究旨在确定从入院时记录有 TEP 的住院护理机构转出的患者比例，检查这些 TEP 是否在住院期间进行了修订，并评估患者在就诊后 14 天的结果。方法 我们审查了一个月内通过急诊科转诊入院的患者名单，并确定了从住宿护理机构就诊的患者名单。我们排除了 65 岁以下的人。我们审查了相关医疗记录，并将匿名数据收集到受密码保护的计算机上的 Excel 电子表格中。结果我们确定了 34 名患者的相关患者。 31 例患者（17 名男性；年龄范围 66 至 96 岁，平均年龄 82.3 岁）的注释可供审查。在所审查的 31 例病例中，平均临床衰弱评分为 7.4。住宿护理机构发送了概述 19/31 案例中 TEP 的文件。在这些情况下，4/19 指定了全面复苏。其中 3/4 的病例在入院期间修改了 TEP。在一个案例中，文件显示患者在任何情况下都不想被转移到医院。共有 14 名患者没有有关 TEP 的文件。其中，7/14 在入院期间继续填写了 DNA 心肺复苏指令。就诊后 14 天，7 人在医院死亡，16 人出院返回住宿护理机构，其余人仍在住院。 结论 这些发现强调需要更好的预先护理计划，有可能改善患者管理并减轻患者、医疗保健提供者和家庭在关键时刻的情绪负担。