A1 Differential diagnosis in relation to Huntington's disease

Abstract

<h3>Background</h3> Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) forms were introduced to St Michael’s Hospice (SMH) in July 2019 and have been adopted throughout the UK to assist in Advance Care Planning. The form is a key enabler facilitating cross organisational efforts to support individuals to die in their preferred place of care. <h3>Method</h3> Retrospective case note review of hospice inpatient admissions over a 3-month period. ReSPECT forms were evaluated using a proforma, assessing the completeness of the form as well as the quality using the commissioned initiative, Frail and Vulnerable Patients Scheme (FVPS) with a global scoring 1–5, based on content. <h3>Results</h3> 65 ReSPECT forms were identified for analysis. Forms were completed in hospital (44%) and hospice (45%) settings, with a smaller number from GP settings (11%). High completion of clinical recommendations (85%), resuscitation decision (98%) with low completion rate of patient preferences; priorities of care (54%) and what is important to the patient (42%). 55% of forms were assessed as higher quality, scoring 4 or 5 on FVPS. A proportion were assessed as low quality (18% (1) 9% (2). Of the forms scoring 4 or 5, most were completed in the hospice (19) followed by those completed in hospital (13) and then GP settings (4). <h3>Conclusions</h3> The piece of work identified the majority of ReSPECT forms completed were of high quality and had high completion rate for clinical recommendations and resuscitation decisions. Interestingly, forms completed within a hospice setting were assessed to be of higher quality. This quality improvement process used standard reporting and benchmarking quality standards to compare across the health economy. This emphasises the need for services to use co-created tools both in terms of assessment and governance.