42 Treatment Escalation Plan (TEP) Completion in General Surgical Admissions in Aberdeen Royal Infirmary

Abstract Aim To assess the completion rate and timeliness of Treatment Escalation Plans (TEPs) for patients aged ≥65 years admitted to the acute general surgical ward (Ward 208) at Aberdeen Royal Infirmary, and to implement interventions aimed at improving compliance with NHS Grampian recommendations. Method A retrospective audit was conducted on patients admitted to Ward 208 between 31/03/2025 and 21/04/2025. Patients under 18 or admitted for less than 24 hours were excluded. Data were collected using TrakCare. The primary outcome was the proportion of patients aged ≥65 with a completed and endorsed TEP within 72 hours of admission. Secondary outcomes included time to TEP completion and documentation of DNACPR alongside TEP. Results Out of 109 total admissions, 55 patients (50%) were aged ≥65. Only 7 TEPs were completed, all for patients ≥65, giving a completion rate of 12.7% in this subgroup. The average age of patients with completed TEPs was 77 years. The mean time to TEP completion was 5.7 days (range 1–11). Only 1 of 7 TEPs was endorsed by a consultant. Of 15 DNACPR forms completed, 5 were accompanied by a TEP. Interventions including CME presentations, staff email reminders, promotion of TEP discussions during ward rounds, and visual prompts were introduced to address barriers and improve TEP compliance. Conclusions Baseline data reveal suboptimal TEP completion for older surgical patients, with delays in documentation and limited consultant involvement. Targeted interventions aim to improve early TEP completion and adherence to NHS Grampian guidelines in future audit cycles.