Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients

Claire E. Johnson, Jeffrey C. Chong, Anne Wilkinson, Barbara Hayes, Sonia Tait, Nicholas Waldron

    Research output: Contribution to journalArticle

    1 Citation (Scopus)

    Abstract

    BackgroundAdvance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR.

    AimTo assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients.

    MethodsA pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer.

    ResultsWhen compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03).

    ConclusionAn increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care.

    Original languageEnglish
    Pages (from-to)798-806
    Number of pages9
    JournalInternal Medicine Journal
    Volume47
    Issue number7
    DOIs
    Publication statusPublished - Jul 2017

    Cite this

    @article{dcfe52be6bea4363886e766a6f76f3c7,
    title = "Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients",
    abstract = "BackgroundAdvance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR.AimTo assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients.MethodsA pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer.ResultsWhen compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95{\%} confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95{\%} CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03).ConclusionAn increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care.",
    keywords = "do-not-resuscitate orders, decision-making, communication, advance care planning, medical futility",
    author = "Johnson, {Claire E.} and Chong, {Jeffrey C.} and Anne Wilkinson and Barbara Hayes and Sonia Tait and Nicholas Waldron",
    year = "2017",
    month = "7",
    doi = "10.1111/imj.13454",
    language = "English",
    volume = "47",
    pages = "798--806",
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    publisher = "John Wiley & Sons",
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    }

    Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients. / Johnson, Claire E.; Chong, Jeffrey C.; Wilkinson, Anne; Hayes, Barbara; Tait, Sonia; Waldron, Nicholas.

    In: Internal Medicine Journal, Vol. 47, No. 7, 07.2017, p. 798-806.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients

    AU - Johnson, Claire E.

    AU - Chong, Jeffrey C.

    AU - Wilkinson, Anne

    AU - Hayes, Barbara

    AU - Tait, Sonia

    AU - Waldron, Nicholas

    PY - 2017/7

    Y1 - 2017/7

    N2 - BackgroundAdvance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR.AimTo assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients.MethodsA pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer.ResultsWhen compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03).ConclusionAn increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care.

    AB - BackgroundAdvance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR.AimTo assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients.MethodsA pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer.ResultsWhen compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03).ConclusionAn increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care.

    KW - do-not-resuscitate orders

    KW - decision-making

    KW - communication

    KW - advance care planning

    KW - medical futility

    U2 - 10.1111/imj.13454

    DO - 10.1111/imj.13454

    M3 - Article

    VL - 47

    SP - 798

    EP - 806

    JO - Internal Medicine Journal (Print)

    JF - Internal Medicine Journal (Print)

    SN - 1444-0903

    IS - 7

    ER -