Improving the Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) process: Insights from qualitative interviews one year into the rollout at Nottingham University Hospitals

Introduction The Recommended Summary Plan for Emergency Care and Treatments (ReSPECT) is a nationally recognised advance care planning tool used to try to ensure that patients receive care in line with their preferences and medical needs. It has been used nationally across the United Kingdom (UK) since 2016 (1). Until 2024 it was not routinely used at Nottingham University Hospitals (NUH). Over the course of 2024/2025 DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) forms were phased out at NUH and replaced with ReSPECT forms. ReSPECT forms are now the sole documentation method for resuscitation decisions at NUH in adult patients. This has been a significant change at NUH, so this quality improvement activity has been designed to evaluate the use of ReSPECT since the roll-out at NUH. It aims to identify what has worked well, what could be improved and any issues that have arisen since the ReSPECT form has replaced the DNACPR form. Method Interviews were conducted with staff members directly involved in using ReSPECT forms. The purpose was to capture an in-depth insight into their experiences, challenges faced in practice, and views on improving the process. Interviews were audio-recorded, transcribed, and anonymised to ensure confidentiality. Data was analysed using thematic analysis, allowing recurring themes and patterns to emerge from staff perspectives. Findings Twenty-three staff were interviewed from different medical specialties and roles. Overall, the ReSPECT process is welcomed at NUH. Staff felt that it can add value to patient care and have a positive impact on workload and finances. Some participants felt that a single uniform approach to ReSPECT is not appropriate for all clinical settings. The study raised the possibility that there may still be a role for a standalone DNACPR decision especially in acute settings, for example The Emergency Department, or whether the ReSPECT process can, and should, be tailored by the clinician to different clinical settings. Moving to a digital form was identified as the single most important immediate change. Discussion This study highlights a need for ReSPECT to move from a reactive to a proactive process starting with earlier identification of patients at risk. This shift will require investment in education, both for clinicians and the public. It will take time to embed and will require resources and a cultural change to talk about end-of-life. The data showed that the clinical value of ReSPECT directly relates to the quality of the conversation and documentation of the ReSPECT form. It is clear that the quality of ReSPECT forms needs to improve. Clearer processes, digital forms, normalising conversations about death and dying, proactive identification of patients in the community, training and protected time to complete high-quality ReSPECT forms would help achieve this. These ideas align strongly with the NHS Long Term Plan—shifting analogue to digital, hospital to community and sickness to prevention (2).