Asian Journal of Internal Medicine (Jan 2022)
Improving decision making, communication and documentation regarding advanced resuscitation decisions in a tertiary care hospital in Sri Lanka
Abstract
Background: Resuscitation decisions made in advance are especially important to prevent negative patient outcomes at end-of-life. We conducted a clinical audit to assess the current practice of these decisions in Sri Lanka and then introduced interventions to improve the same. Methods: An auditor-administered questionnaire developed through a focused group discussion among experts was used to analyse the medical records of deaths during a period of sixty days focusing on advanced resuscitation decisions and factors affecting them. The junior doctors directly involved in the care of each patient were interviewed regarding their retrospective judgement about the most appropriate resuscitation decision, which was later compared with the decision of an expert panel, who decided on the most appropriate resuscitation decision based on the medical records of the patient. An educational session for doctors was then conducted to improve their knowledge about advanced resuscitation decisions including the importance of meticulous documentation of such decisions. The outcome was assessed after sixty days following the introduction of the intervention using the same questionnaire. Results: There was a significant improvement in the number of documented advanced resuscitation decisions from 4/40 (10%) to 17/38 (44.73%) (Z=3.5, P=0.0006), with a significant increase in DNACPR decisions from 4/40 (10%) to 14/38 (36.8%) (Z= 2.8, P=0.005) following the intervention. Unsuccessful CPR attempts decreased significantly from 31/40 (77.5%) to 14/38 (36.8%) (Z=3.6, P=0.0003) in the post-intervention period. The resuscitation decisions suggested by junior doctors that matched with expert decisions increased significantly for both interns ((from 11/40 (27.5%) to 22/38 (57.9%) (Z=2.7, P=0.0066)) and registrars ((18/40 (45%) to 27/38 (71.05%) (Z=2.3, P=0.0202)) in the post-intervention period. Conclusion: Documentation and practice regarding advanced resuscitation decisions are suboptimal in Sri Lanka. This can be improved by interventions targeting improving the knowledge about the concept and its proper documentation among health care professionals.
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