Introduction
Completing Acute Resuscitation Plans (ARPs) in the hospitalised elderly population is formidably challenging, considering the impact of disease burden, cognitive impairment and frailty that is often present (1). This task often falls to our embattled medical registrar colleagues, who receive little to no formal instruction on how to lead such conversations.
Aim
To evaluate the usefulness of a clinician information sheet in assisting medical registrars to complete ARP discussions and documentation; and to evaluate issues associated with this process.
Method
An online survey was sent out via email to 38 rotational medical registrars at a regional tertiary teaching hospital (Townsville University Hospital). This survey (with clinician information sheet attached) sought to evaluate current practices regarding ARP discussions and documentation. Responses were collected over the span of 2 months and analysed using SPSS and NVivo software.
Results
A total of 16 survey responses were included in the final analysis. Most respondents had no formal training on completing a resuscitation discussion, despite completion of more than 20 ARPs. No standard approach to ARP discussions was identified. Issues with completion of ARP discussion include discrepancies between patient/substitute decision makers’ wishes for resuscitation and medical opinion, lack of information and suboptimal working conditions (Table 1). There was consensus agreement regarding the utility of a clinician information sheet in assisting completion of future resuscitation discussions.
Conclusion
A clinician information sheet may assist medical registrars in completing more comprehensive ARP discussions and documentation. Ongoing focus on barriers identified as above may lead to further improvement in this area.
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Major Themes with participant examples |
Quotes |
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1. Discrepancies in patient/Substitute Decision Maker wishes vs. medical opinion |
“Patients wanting treatment that is not in their best interest.” (Respondent 2) “Difficult patient or family's discussion discrepancy in their wishes and medical decision is difficult part for any doctor to deal with it.” (Respondent 6)
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2. Lack of or limited to access to information |
“Finding formal information regarding EPOA/NOK. Editing the form is time consuming.” (Respondent 1) “Also not being able to easily flip back to your notes to double check med Hx / EPOA details etc is a bit annoying.” (Respondent 5) |
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3. Suboptimal working conditions |
“Suboptimal conditions - during night shift/out of hours, no family available, time and work constraints.” (Respondent 3) |
Table 1: Thematic Analysis of Issues identified by Medical Registrars