title: Goals of patient care system change with video-based education increases rates of advance cardiopulmonary resuscitation decision-making and discussions in hospitalised rehabilitation patients.
abstract: BACKGROUND
  Advance cardiopulmonary resuscitation (CPR) discussions and decision-making are not routine clinical practice in the hospital setting. Frail older patients may be at risk of non-beneficial CPR.
  
  
  OBJECTIVE
  To assess the utility and safety of two interventions to increase CPR decision-making, documentation and communication for hospitalised older patients.
  
  
  METHODS
  A pre-post study tested two interventions: (i) standard ward-based education forums with CPR content; and (ii) a combined, two-pronged strategy with 'Goals of Patient Care' (GoPC) system change and a structured video-based workshop; against usual practice (i.e. no formal training). Participants were a random sample of patients in a hospital rehabilitation unit. The outcomes were the proportion of patients documented as: (i) not for resuscitation (NFR); and (ii) eligible for rapid response team (RRT) calls, and rates of documented discussions with the patient, family and carer.
  
  
  RESULTS
  When compared with usual practice, patients were more likely to be documented as NFR following the two-pronged intervention (adjusted odds ratio (aOR): 6.4, 95% confidence interval (CI): 3.0; 13.6). Documentation of discussions with patients was also more likely (aOR: 3.3, 95% CI:1.8; 6.2). Characteristics of patients documented NFR were similar between the phases, but were more likely for RRT calls following Phase 3 (P 0.03).
  
  
  CONCLUSIONS
  An increase in advance CPR decisions occurred following GoPC system change with education. This appears safe as NFR patients had the same level of frailty between phases but were more likely to be eligible for RRT review. Increased documentation of discussions suggests routine use of the GoPC form may improve communication with patients about their care.
authors.affiliation: School of Surgery, The University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Claire E
authors.identifier: http://orcid.org/0000-0001-9190-8441
authors.initials: CE
authors.lastname: Johnson
authors.affiliation: Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia.
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Chong
authors.affiliation: School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, Australia.
authors.forename: Anne
authors.initials: A
authors.lastname: Wilkinson
authors.affiliation: Advance Care Planning Program, Northern Health, Melbourne, Victoria, Australia.|Medical School, The University of Melbourne, Melbourne, Victoria, Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hayes
authors.affiliation: Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia.
authors.forename: Sonia
authors.initials: S
authors.lastname: Tait
authors.affiliation: Department of Rehabilitation and Aged Care, Armadale Kelmscott Memorial Hospital, Perth, Western Australia, Australia.|Health Strategy and Networks, System Policy and Planning, Department of Health, Government of Western Australia, Perth, Western Australia, Australia.|School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Waldron
mesh_terms: D016223:Advance Directives / Q000639:trends; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000639:trends*; D000066491:Clinical Decision-Making / Q000379:methods; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D005791:Patient Care / Q000379:methods / Q000639:trends; D010347:Patient Care Planning / Q000639:trends*; D010353:Patient Education as Topic / Q000379:methods / Q000639:trends*; D011897:Random Allocation; D012046:Rehabilitation / Q000379:methods / Q000639:trends; D014741:Video Recording / Q000379:methods / Q000639:trends*
keywords: advance care planning; communication; decision-making; do-not-resuscitate orders; medical futility