Researchers at the University of Southampton are working with NHS partners to develop, implement and evaluate a tool known as a Treatment Escalation Plan (TEP); this aims to help patients, their families and healthcare professionals talk about treatment decisions that have to be made when a person is seriously unwell and their health is at risk of deterioration. Many patients whose condition becomes worse face uncertainty about the likelihood of recovery. For patients, families and healthcare professionals deciding on the best thing to do can be hard.
TEPs are developed by the most senior medical clinician looking after the patient in discussion with the patient and family and helps set out what care the medical team feel is appropriate if a patient deteriorates and allows it to be clearly recorded. They can be used to discuss with patients and their next of kin what course of action clinicians think would or would not be appropriate and set limits on medical treatment for those who are very unwell and/or in the event they might deteriorate. They are about judging what could be done and on occasion what should not be done, for example whether to start a new course of antibiotics, put someone on a ventilator or perform dialysis. It also usually includes an indication of whether someone should be transferred to intensive care.
TEPs have the potential to provide clarity of instruction in the event of deterioration and will improve how these types of decisions are approached, discussed and communicated, making conversations between patients, those close to them, and health professionals easier. They provide a way in which these decisions can be documented and shared with other health professionals involved in looking after the patient.
The project encompasses a range of activities: audit, service development, research and evaluation and includes the following activities: