# Enhancing Patient Care Through Improved Escalation Planning and Documentation: A Quality Improvement Project at a District General Hospital

## TL;DR

A hospital improved patient safety by creating a standardized form to better document critical care decisions and handovers.

## Contribution

A standardized proforma was developed and implemented to improve documentation of DNAR, escalation plans, and weekend handovers.

## Key findings

- DNAR documentation improved from 47% to 90% after implementing the proforma.
- Escalation planning documentation increased from 23% to 81%.
- Weekend handover documentation rose from 47% to 100%.

## Abstract

Introduction

Clear escalation plans are critical to patient safety, particularly during periods of out-of-hours work. This is supported by guidance developed by the Royal College of Physicians, which states that all patients should have an escalation plan documented. Despite this, documentation is often inconsistent due to the complexity and time-consuming nature of these decisions. Nevertheless, accessibility to this information is imperative for effective handover between clinical teams and contributes towards delivering safe patient care.

Methods

The Plan-Do-Study-Act (PDSA) cycle methodology was used. Thirty patient notes were reviewed to assess the clarity of documentation regarding do not attempt cardiopulmonary resuscitation (DNAR) decisions, escalation planning, and weekend handover. Based on these findings, a standardised proforma was developed to evaluate the impact of the intervention on clinical practice. Subsequent PDSA cycles were implemented across the Gastroenterology ward.

Results

Following the introduction of the proforma, there were significant improvements in the quality of documentation. DNAR documentation increased from 47% to 90%, escalation planning improved from 23% to 81%, and weekend handover documentation rose from 47% to 100%.

Conclusion

The use of a standardised proforma improved the documentation and handover of patients in the Gastroenterology ward. This project demonstrated the positive impact of using a structured format to record key clinical information, thereby contributing to safer patient care. As a result, the proforma has been adopted by other wards within the hospital.