A Resident-Led Quality Improvement Program for Increasing Documentation of Advance Care Planning Discussions (FR407-C)

Abstract

1.Describe the design of a resident-led quality improvement program that included a financial incentive to increase rates of documentation of advance care planning discussions in the medical record.2.Detail the effects of the intervention on rates of documentation of advance care planning discussions.3.Identify key components that contributed to the program's success. Advance care planning (ACP) discussions ensure that end of life care is in accord with patients’ preferences. Inconsistent documentation of inpatient discussions puts patients at risk for unwanted interventions after discharge. To design and implement a resident-led quality improvement program including a financial incentive to ensure that the results of inpatient ACP discussions are available across care transitions. In response to frustration about inconsistent documentation of ACP discussions, two internal medicine residents, in coordination with program faculty, designed a multimodal quality improvement project to encourage residents to assess and document patients’ wishes for end of life care. A field was incorporated into the electronic discharge summary template for residents to document details of ACP discussions occurring during admission. We set a goal for residents to document discussions in the template for 75% of discharged patients. The program included: 1) financial incentive of $400 dollars per resident if goal reached from July 1st, 2011 to May 31st, 2012; 2) providing real time biweekly email feedback about individual rates of completion; 3) monthly education at chief resident orientations and quality improvement conferences. Rates of successful completion increased from 21% to around 90% over the course of the program. Key factors contributing to program success included the resident-led nature of the project, frequent audit and feedback, and the financial incentive. Assessment of sustainability is ongoing. A resident-led quality improvement program including a financial incentive resulted in significant increases in the documentation of ACP discussions in an easy location for outpatient and inpatient providers to locate across care transitions.