Resuscitation status
Table 2 shows that documentation regarding resuscitation status could only be found in 42 health records (of the 390 sets of notes with sufficient data available for review). Table 3 shows the predicted risk of death on admission to hospital and Table 4 shows the predicted risk of death on referral to the ICU (predicted by referring physician) in the group of patients who died. It is clear that a large number of acute medical admissions in this group were considered to be at high risk of death (expected or at definite risk) - 229 on admission to hospital and 325 at referral to ICU in this study. It is disappointing that only 42 health records contained statements about resuscitation status. This is clearly not in line with GMC guidance.
| Table 2. Statement of resuscitation status in health records |
| Resuscitation status documented |
Total |
(%) |
| Yes |
42 |
(11) |
| No |
348 |
(89) |
| Sub-total |
390 |
|
| Insufficient data |
49 |
|
| Total |
439 |
|
| Table 3. Predicted risk of death at hospital admission (group of patients who died) |
| Risk of death at hospital admission |
Total |
(%) |
| Not expected |
40 |
(12) |
| Small but significant risk |
58 |
(17) |
| Definite risk |
182 |
(53) |
| Expected |
47 |
(14) |
| Unable to define |
15 |
(4) |
| Sub-total |
342 |
|
| Not answered |
97 |
|
| Total |
439 |
|
| Table 4. Predicted risk of death on referral to ICU (group of patients who died) |
| Risk of death on leaving the ward |
Total |
(%) |
| Not expected |
1 |
(0) |
| Small but significant risk |
7 |
(2) |
| Definite risk |
234 |
(68) |
| Expected |
91 |
(27) |
| Sub-total |
342 |
|
| Not answered |
106 |
|
| Total |
439 |
|
Where a statement regarding resuscitation could be found, an attempt was made to assess whether discussion had taken place with the patient and/or family. This data is shown in Tables 5 and 6. There was a surprising lack of discussion with patients about this aspect of their treatment. Whilst there was greater family discussion, there were still a number of patients in whom it appeared that decisions about resuscitation had been made without involvement of either party.
| Table 5. Discussion with patients of resuscitation statement |
| Patient discussion |
Total |
| Yes |
2 |
| No |
21 |
| Sub-total |
23 |
| Insufficient data |
19 |
| Total |
42 |
| Table 6. Discussion with patients' families of resuscitation statement |
| Family discussion |
Total |
| Yes |
17 |
| No |
8 |
| Sub-total |
25 |
| Insufficient data |
17 |
| Total |
42 |
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