Capturing Wishes: A Novel Approach to Goals of Care Documentation for Inpatient Palliative Care Consults (QI713)

Abstract

1.Identify the need for improved goals of care documentation in the inpatient electronic medical record among patients seen by an inpatient palliative care service.2.Articulate a strategy for improving goals of care documentation among patients seen by an inpatient palliative care service. Patients with life-threatening illness face critical decisions regarding goals of care (GOC) and treatment preferences (TP). Palliative Care (PC) consultants play a pivotal role in clarifying and documenting patients’ wishes to ensure they receive goals-aligned care. However, inconsistencies in documentation of GOC/TP in the electronic medical record (EMR) can result in patients receiving interventions incongruent with their preferences. Among a baseline sample of patients seen by the University of California San Francisco (UCSF) PC service for GOC discussions in April and May 2017, only 63.3% had any goals documented in the EMR, and only 54.5% had both overall GOC (e.g., curative) and at least one specific TP specified in addition to code status (e.g., artificial nutrition, dialysis, etc). This quality improvement study examined the impact of an easily accessible, highly reproducible EMR note template on the consistency of GOC/TP documentation for patients seen by the UCSF PC service. This study aimed to increase documentation of GOC/TP among patients seen for GOC by the UCSF PC service from 54% to 80% with the use of a note template designed to integrate into the Advance Care Planning (ACP) problem in Epic. Study authors designed an Epic note template to facilitate consistent documentation of GOC/TP. The PC service encouraged routine use of the dot phrase by all consulting PC physicians. Analysts assessed compliance at monthly intervals. Among 640 patients seen by the UCSF PC service between September 2017 and May 2018, 466 (72.8%) were seen for GOC. Of these, 461 patients (98.9%) had documentation of both overall GOC and at least one TP in their ACP problem in Epic. Implementation of an EMR note template increased consistency and clarity of GOC/TP documentation for patients seen by the PC consult service.