Improving Completion Rates of Treatment Escalation Plan (TEP) in a London Teaching Hospital: A Quality Improvement Study.

Background Treatment escalation plans (TEPs) provide enhanced clarity in planning appropriate decision-making in the management of deteriorating patients by explicitly defining a limit of care. These decisions are discussed with patients or their relatives and mutually agreed upon. We aimed to improve staff adherence to the completion of TEPs upon the admission of patients to the orthopedics wards in a London teaching hospital. Methods This study employed the Plan-Do-Study-Act (PDSA) methodology to investigate the efficacy of interventions implemented within a hospital setting for adult inpatients receiving orthopedic treatment. The approach adopted was cross-sectional, where a comprehensive audit was conducted on all adult inpatients admitted to the hospital. The initial cycle of the study was conducted in March 2022, followed by the implementation of interventions in the form of an internal algorithm. Subsequently, the second cycle of the study was conducted in November 2022. Results We sampled a total of 50 patients (PDSA 1, n=27; PDSA 2, n=23). Following the implementation of a designated local TEP pathway, the proportion of patients with incomplete TEPs fell from 30.4% (n=7, PDSA Cycle 1) to 11.76% (n=2, PDSA Cycle 2). Conclusions The study has demonstrated that interventions such as institutional algorithms and departmental meetings can be useful in improving the adherence of staff to complete TEPs. Ongoing training and education can help overcome some of the barriers to TEP completion.