Characterising Trends in the Initiation, Timing, and Completion of Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) Plans: Retrospective Analysis of Routine Data from a Large UK Hospital Trust

Aim: To assess patient socio-demographic and disease characteristics associated with the initiation, timing, and completion of emergency care and treatment planning in a large UK-based hospital trust.

Methods: Secondary retrospective analysis of data across 33 months extracted from digitally stored Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans within the electronic health record system of an acute hospital trust in England, UK.

Results: Data analysed from ReSPECT plans (n=23,729), indicate an increase in the proportion of admissions having a plan created from 4.2% in January 2019 to 6.9% in September 2021 (mean = 8.1%). Forms were completed a median of 41 days before death (a median of 58 days for patients with capacity, and 21 days for patients without capacity). Do not attempt resuscitation was more likely to be recorded for patients lacking capacity, with increasing age (notably for patients aged over 74 years), being male, having ethnicity recorded as ‘Asian or Asian British’ or ‘Black or Black British’, and the absence of multiple disease groups. Having a preferred place of death recorded as ‘hospital’ led to a five-fold increase in the likelihood of dying in hospital.

Conclusion: Variation in the initiation, timing, and completion of ReSPECT plans was identified by applying an evaluation framework. Digital storage of ReSPECT plan data presents opportunities for assessing trends and completion of the ReSPECT planning process and benchmarking across sites. Further research is required to monitor and understand any inequity in the implementation of the ReSPECT process in routine care.