Urgent and emergency care

Our work aims to support the delivery of urgent and emergency care (UEC) by reducing complexity for patients, carers and healthcare staff, and ensuring it better serves those with a serious or life threatening emergency.

UCLPartners is currently running a project to develop educational materials to train health and care professionals in ReSPECT (Recommended Summary Plan for Emergency Care and Treatment, released in February 2017).

The challenge

The Resuscitation Council (UK) has led the development of ReSPECT in the light of evidence revealing variation and suboptimal practice in Do not attempt cardiopulmonary resuscitation (DNACPR) decision making and communication, particularly between settings, and the benefit of including such decision making within a broader discussion about emergency care and treatment.

The north central London context

In north central London, there is currently no unified process for recording decisions related to emergency care and treatment, including DNACPR, that is valid when a person moves setting. Of the 1.45 million population within the North Central London Sustainability and Transformation Partnership (NCL STP), approximately 8,000 people die annually; 52% of which do so in hospital.

What is ReSPECT?

ReSPECT is a new process for clinicians, patients and their families to create personalised recommendations for a person’s clinical care in a potential future emergency in which they are unable to make or express choices.

The recommendations are recorded on a  personalised summary plan which moves with the patient across care settings. ReSPECT involves compassionate conversations and proactive planning and considers both patient preferences and clinical judgement.

ReSPECT can be for anyone, but will have increasing relevance for people who have complex health needs, including those with long-term or life-limiting conditions and  people who are likely to be nearing the end of their lives.

What we’re doing

UCLPartners has been awarded funding from Macmillan Cancer Support and the Royal College of Nursing Foundation to develop educational materials (a web-based app and face-to-face training) to train health and care staff in the ReSPECT process and to test the implementation of ReSPECT in a local health economy.

The aims of the UCLPartners ReSPECT project are:

  • To improve understanding of ReSPECT amongst health and care professionals through the development of a web app and other educational resources
  • To test the implementation of ReSPECT using QI methodology in a small number of care homes and their local care economy in London

The ReSPECT process is being implemented in three care homes in Islington, north London. Training and support is also being extended to aligned GP practices and two hospitals (University College London Hospital and Whittington Hospital NHS Trusts) to which residents are typically referred should they require emergency medical treatment. We are also providing training in ReSPECT to services in the wider health economy (e.g. London Ambulance Service and out-of-hours GPs) as part of the pilot implementation.

The project commenced in September 2017 and will run until the end of August 2018. The effectiveness of ReSPECT will be tested using a simple Quality Improvement approach using improvement cycles, learning workshops, and data collection.

The learning from the UCLPartners ReSPECT project is intended to inform roll-out of ReSPECT across the NCL STP and nationally.

Progress highlights

  • The ReSPECT app was launched in September 2017 at NHS Expo
  • The ReSPECT app can be accessed free of charge via respectprocess.org.uk/learning
  • The app can be used on a range of devices and can be customised according to the learner’s profession
  • The ReSPECT web app had 600 unique users within two months of launching and has been used nearly 2000 times
  • Testing of the implementation of the ReSPECT app and supported introduction of the ReSPECT process started in September 2017
  • The first Quality Improvement cycle has been completed in a care home in Islington

A face to face curriculum is currently being developed to complement the content of the web-application learning.

Leadership and contacts

Anna Gorringe – End of Life Care Lead, UCLPartners

Nadine Pfeifer – Project Manager, UCLPartners