A physician-led team approach to improve advance directive completion rates in an inpatient oncology unit.

Abstract

e18271 Background: Advance care planning (ACP) ensures that patients receive care which is consistent with their beliefs and preferences. Advance directive (AD) completion is an important part of this process, but there is much room for improvement as the AD completion rates in oncology patients have been reported to be as low as 10%. We sought to improve the AD completion rates in the inpatient oncology unit in our institution by undertaking an 8-week quality improvement project. Methods: Using a Plan-Do-Study-Act (PDSA) methodology, a multidisciplinary team lead by residents was created to review the process. 2 cycles of PDSA were conducted over a period of 8 weeks. Electronic medical record (EMR) was reviewed each morning, new patients admitted to oncology unit were identified, and those without AD on file were educated by a designated resident about the importance of completing AD. Based on the patients’ willingness, the case manager was alerted with daily communication to follow-up, provide more information and assistance to file the AD. The AD completion rates were tracked daily and communicated to the team through an e-mail. Results: Only 8.3% of hospitalized oncology patients had completed AD prior to our intervention. PDSA cycle 1 resulted in improving the AD completion rates to 28.9%. Barriers were identified after cycle 1 and were overcome by clarifying the role of each team member, addressing inconsistencies in AD filing, uploading into EMR and making the scanned AD easily accessible. After implementation of the above measures, PDSA cycle 2 resulted in improving the AD completion rates to 40.9%. Conclusions: Designating a person to take lead of a multi-disciplinary team, addressing the inconsistencies in the process and keeping a daily track through EMR can lead to an improvement in AD completion rates. Sustainability of this projects remains to be tested. However, there is a room for further improvement.