An investigation of decision making around treatment escalation
Research type
Research Study
Full title
An investigation of the natural history of decision making around treatment escalation in seriously unwell patients: a retrospective case note review
IRAS ID
215169
Contact name
Alison Richardson
Contact email
Sponsor organisation
University of Southampton
Duration of Study in the UK
0 years, 7 months, 30 days
Research summary
This project aims to gain an in-depth understanding of decision-making processes in the context of deteriorating clinical trajectories through patient case note review. This work will identify opportunities to improve patient care through the use of Treatment Escalation Plans (TEPs), and inform future TEP implementation work.
This work proposes to build upon an audit of routinely collected data at University Hospital Southampton NHS Foundation Trust (UHSFT). UHSFT collects data about deaths in hospital for cause of death review and coroner notification, and records key details of all individuals who die within the Trust on a Death Certificate Review Form (DCRF), normally within 24 hours of death. Data has been collected from 6 months’ worth of DCRFs and analysed to describe the frequency of, and describe the relationships between: admission demographics, characteristics of condition on admission, illness trajectories, escalation decisions/discussions, intensive care involvement, complex clinical/social factors, potentially avoidable and failed discharges, frequency of palliative care team involvement and record of "do not attempt cardiopulmonary resuscitation" order decisions relating to patient deaths.
We want to gain a more in-depth understanding of decision-making surrounding the clinical complexities highlighted by the DCRF audit. This will be facilitated through a case note review. This study will consist of interrogating routine medical records of deceased patients at one NHS Trust (UHSFT) to build upon the audit data from the DCRFs, to better understand the decision-making processes, communication and documentation at times of clinical deterioration, prior to implementation and evaluation of a formalised TEP process.
REC name
South Central - Hampshire A Research Ethics Committee
REC reference
16/SC/0599
Date of REC Opinion
14 Dec 2016
REC opinion
Further Information Favourable Opinion