The impact of the COVID-19 pandemic on the implementation of the ReSPECT process: which patients received a ReSPECT form, what was documented, and what were the patient outcomes?

Problem

ReSPECT (Recommended Summary Plan for Emergency Care and Treatment) is a UK Advance Care Planning initiative, aiming to standardise the process of creating personalised recommendations for a person’s clinical care in a future emergency, and therefore improve patient outcomes. Despite this, implementation across an entire healthcare area and any subsequent outcomes have not yet been studied. Therefore, it is unclear if patients with a ReSPECT form benefit from the positive outcomes associated with good advance care planning. The implementation of ReSPECT in the Bristol, North Somerset and South Gloucestershire (BNSSG) area overlapped with the first UK COVID-19 wave.

This study will aim to describe the characteristics of patients in the BNSSG area who completed the ReSPECT process before, during, and after the first wave; describe the content of ReSPECT forms; and analyse outcomes for those patients who died with a ReSPECT form. This is to determine the equity of the ReSPECT form implementation process and the benefits to patients and their local services.

Approach

Data will be exported from the Systemwide Dataset, a pseudonymised database linking data from organisations providing health and social care to BNSSG patients. This routinely collected data from BNSSG patients will be analysed in two streams:

1. An observational cross-sectional study of patients who completed the ReSPECT process October 2019- October 2020. Summary statistics will be used to describe sociodemographic and medical variables and ReSPECT form items. These variables will be described across three periods of the first COVID-19 wave.

2. A retrospective cohort study of patients who died October 2019- October 2020. Outcomes during this period will be compared between those patients who had completed the ReSPECT process and those who had not, using adjusted regression models. These outcomes are: A&E attendances, emergency admissions, district nurse visits, hospice referrals, anticipatory prescriptions and whether the patient died in their preferred place of death.

Findings

Results will be presented at conference.

Consequences

This study will explore the ReSPECT form’s link to the evidence base for good advance care planning. Additionally, we aim to highlight barriers to implementation (COVID-19 related and otherwise) and any issues of implementation inequality. Our findings will potentially inform future implementation processes across other areas of the UK.