Applying mortality data to improve emergency care planning for haemodialysis patients: a quality improvement project
Introduction: The Learning from Deaths Framework,1 published in 2017, mandates that NHS Trusts undertake mortality reviews to identify areas of good care and areas of improvement within care delivery systems, ensuring appropriate lessons are learnt and sustainable changes are implemented.A Recommend...
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| Main Authors: | , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
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| Series: | Future Healthcare Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2514664525001523 |
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| Summary: | Introduction: The Learning from Deaths Framework,1 published in 2017, mandates that NHS Trusts undertake mortality reviews to identify areas of good care and areas of improvement within care delivery systems, ensuring appropriate lessons are learnt and sustainable changes are implemented.A Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) form,2 which includes the agreed clinical recommendations on whether emergency treatment should be commenced in the event of a cardiopulmonary arrest, is completed with patients prior to any clinical deterioration to ensure appropriate care is delivered in line with their wishes.Chronic haemodialysis patients often have multiple co-existing health conditions, exhibit frailty, and have complex hospital admissions.3 Analysing mortality data can help identify care themes and patterns within this patient population, offering valuable insights for quality improvement initiatives. Methods: Phase 1: a retrospective mortality case-note assessment using the Structured Judgement Review (SJR) methodology was conducted covering deaths from October 2020 to May 2023 in a tertiary renal unit. Cases involving cardiac arrest underwent further analysis, examining factors including their Clinical Frailty Score4 and the presence of a ReSPECT form.2 This review identified the underutilisation of ReSPECT forms in frail haemodialysis patients.Phase 2: we expanded the review of ReSPECT form use beyond cardiac arrest cases to include all haemodialysis patients who underwent an SJR in the same time frame, thus providing a broader perspective on ReSPECT form usage within the whole cohort.Phase 3: an intervention in the form of a departmental educational campaign, emphasising the high mortality rate among frail haemodialysis patients and, thus, the importance of advance care planning, was carried out. As a result, the review of ReSPECT form status was incorporated as a standard practice in haemodialysis clinics and multidisciplinary meetings.Phase 4: following the intervention, we re-audited the proportion of haemodialysis patients who underwent an SJR from May 2023 to February 2025 and had a completed ReSPECT form in situ. Results: 24 cardiac arrest cases were identified through the review of mortality data from October 2020 to May 2023 (Fig 1).The following frail haemodialysis patients are examples of cases without a ReSPECT form in place, although this list is not exhaustive: • An 84-year-old patient with a significant cardiac history. • A 59-year-old patient with severe emphysema and history of lung cancer. • An 86-year-old patient with a Clinical Frailty Score of 5 who recently started haemodialysis.Following the intervention, the re-audit revealed an 11% increase in the proportion of haemodialysis patients who had a valid ReSPECT form at the time of death (Fig 2). Conclusion: Reviewing mortality data provides valuable insights into the care received by our patients and helps identify key themes for improvement within our patient population. This process informs teams and departments where resources need to be focused to improve patient experience.By launching an educational initiative and integrating ReSPECT form reviews as a fundamental aspect of routine haemodialysis clinics and multidisciplinary meetings, we can enhance ReSPECT form implementation to facilitate appropriate emergency care decisions. |
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| ISSN: | 2514-6645 |