Utilizing the Huddle for Meaningful Conversations about Goals of Care and Advance Directives

Abstract

Oftentimes, the conversations that are needed the most to understand patient care goals, especially in the context of serious illness or end of life, are often not talked about. Patients’ goals of care and advance directives tend to happen too late or are avoided. Early discussions about goals of care are associated with better quality of life, can avoid non-beneficial medical care, and more importantly, improve family outcomes. At our hospital in rural Missouri, we proactively communicate goals of care in our regular clinical care processes. Our multidisciplinary huddle is a good opportunity to incorporate goals of care and improve outcomes. This is a time to identify emerging events and potential geriatric-related issues, express concern, discuss discharge, and coordinate difficult conversations. By implementing huddle, we removed barriers by equipping participants with details and tools to have crucial conversations and update treatment plan with the cohesive group to derive 1 common shared patient goal. We use the opportunity of the huddle to identify patients who are high risk for readmission or may need to be transitioned to skilled nursing. Furthermore, huddle is an opportunity to align team members on patient specific advance directive wishes that impact medical decision making processes. The objective is to improve the frequency of discussions of goals of care and advance directives by incorporating it into the inpatient huddle.