TPTh 8.13 Escalation Planning in Acute General Surgery: Persistent Gaps Highlighted in a 300-Patient Audit

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ID: 324029
2026
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Abstract
Abstract Background National guidance from the UK Resuscitation Council emphasises timely documentation of Treatment Escalation Plans (TEP) and Do-Not-Attempt-CPR (DNACPR) decisions to support safe, individualised care. Early escalation planning is particularly important in elderly and multimorbid surgical patients. This audit evaluates compliance with local trust standards requiring documentation within 24 hours of admission. Methods A retrospective audit was conducted at James Cook University Hospital reviewing unplanned general surgical admissions from July 2025 to September 2025. A total of 300 patients were included in the study. Variables included demographics, Charlson Comorbidity Index (CCI), documentation of ceiling-of-care plans, DNACPR decisions, and timing relative to admission. Results Of the 300 patients (median age 70; 52% male), 68% had significant comorbidity (CCI ≥4). Ceiling-of-care decisions were documented in 18% of cases (n=54), reflecting persistently poor compliance with the 24-hour standard. Only 6% (n=18) had TEP or DNACPR documentation completed within 24 hours. DNACPR decisions were present in 12% (n=36), but 40% of these lacked clear documentation in admission clerking notes. Patients requiring ward-based ceilings of care had notably higher CCI scores (median ≥7). Among those with hospital DNACPR orders, only half were documented in a timely manner. Conclusions Escalation planning in general surgical admissions remains significantly below expected standards. High-risk patients frequently do not receive timely or clearly documented TEP or DNACPR decisions. Targeted interventions—including structured training for junior doctors and strengthened admission proformas—are recommended, with plans for re-audit following implementation.
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Authors Mohammed Arifuzaman
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.514
URL
https://doi.org/10.1093/bjs/znag087.514
Keywords Keywords not found

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