Resident-Led Effort Improves Adoption of Advance Care Planning among Emergency General Surgery Patients

Abstract

INTRODUCTION: Advanced Care Planning (ACP) is underused in surgery, especially among older adults undergoing high-risk operations. For patients who may permanently or temporarily lose their ability to communicate preferences, pre-operative ACP and identification of a surrogate decision-maker is often the only mechanism to guide medical decision-making. METHODS: A resident-led, collaborative (faculty, advanced practice providers [APP], medical student, and nurse) quality improvement project including education (grand rounds, case-based conferences, didactic sessions), performance measurement and financial incentives, conducted on the Emergency General Surgery (EGS) service aimed to increase use of a tailored surgical template in the ACP tab in the electronic health record (EHR). 566 patients in the baseline period (2020-2021) were compared to 423 patients in the project period (2021-2022). Residents were surveyed about barriers to adoption. RESULTS: ACP compliance increased by 8.1% (10.1% to 18.2%) with a greater increase noted in patients age 65+ (20.3% vs 34.3%). Residents and APPs completed ACP, usually by integrating into patient admission workflow (52.1% within the first 24 hours of admission). For major cases, ACP compliance rates increased by 19.7% (18.9% to 38.6%). Residents surveyed (n = 19), all of whom had an ACP conversation all recognized the importance of ACP, noted barriers, including competing clinical duties (50%), patient or family hesitancy (30%), and language barriers (15%), (Table 1). CONCLUSION: A resident-APP partnership was effective at increasing ACP adoption on an EGS service. Further study is needed to identify approaches to facilitate ACP conversations in EGS patients with limited English proficiency.Table 1