Quality Improvement Project for Advance Care Planning Tool in Hospital Medicine
Study Details
Study Description
Brief Summary
Hospitalized patients and their families are often unprepared regarding end-of-life care. Even patients with high risk of mortality within the index admission or 30 days after admission often do not have clearly defined goals of care. This lack of clarity can create difficult scenarios for patients, their families, and care providers. Lack of communication and documentation of these goals can lead to unnecessary tests, procedures, and readmissions. By creating advanced care planning education for the hospital medicine department, a standardized note template, and EMR utilization for storage and reference of patient's goals of care documentation we aim to facilitate the conveyance of patient's wishes/preferences across different care providers and across separate encounters within the healthcare system. For this study, we will use a pre-post study design to evaluate the implementation of this quality improvement intervention.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| High risk of mortality Adult patients admitted to the hospital medicine service with a high risk of mortality |
Other: Advance Care Planning Discussion
Goals of care discussion with patient, documentation with electronic health record note and advance care planning billing. This will also include: pharmacy review of medications, case management review, and coding specialist review.
|
| High risk of mortality (pre-implementation) Adult patients admitted to the hospital medicine service with a high risk of mortality |
Outcome Measures
Primary Outcome Measures
- Proportion of patients who have advanced care planning notes completed during the admission [Hospital admission, up to 7 days]
As measured by medical record review (Pre-implementation)
- Proportion of patients who have advanced care planning notes completed during the admission [Hospital admission, up to 7 days]
As measured by medical record review (Post-implementation)
Secondary Outcome Measures
- Proportion of patient who have documentation utilizing the electronic health record dotphrase note template [Hospital admission, up to 7 days]
As measured by medical record review (Pre-implementation)
- Proportion of patient who have documentation utilizing the electronic health record dotphrase note template [Hospital admission, up to 7 days]
As measured by medical record review (Post-implementation)
- Proportion of patients who are billed for advanced care planning [Hospital admission, up to 7 days]
As measured by medical record review (Pre-implementation)
- Proportion of patients who are billed for advanced care planning [Hospital admission, up to 7 days]
As measured by medical record review (Post-implementation)
- Proportion of patients who receive palliative care consults [Hospital admission, up to 7 days]
As measured by medical record review (Pre-implementation)
- Proportion of patients who receive palliative care consults [Hospital admission, up to 7 days]
As measured by medical record review (Post-implementation)
- Proportion of patients who are discharged to hospice [Hospital discharge, up to 7 days]
As measured by medical record review (Pre-implementation)
- Proportion of patients who are discharged to hospice [Hospital discharge, up to 7 days]
As measured by medical record review (Post-implementation)
- Proportion of patients who have an appointment to the palliative care clinic [Up to 1 month]
As measured by medical record review (Pre-implementation)
- Proportion of patients who have an appointment to the palliative care clinic [Up to 1 month]
As measured by medical record review (Post-implementation)
Eligibility Criteria
Criteria
Inclusion Criteria:
- All patients admitted to the inpatient medicine service with high risk of mortality.
Exclusion Criteria:
- Involuntary commitment during the index admission
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Duke University | Durham | North Carolina | United States | 27705 |
Sponsors and Collaborators
- Duke University
Investigators
- Principal Investigator: Sendak Mark, Duke University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- Pro00104527