Increasing advance care planning in the secondary care setting: A quality improvement project

Abstract

BACKGROUND: Advance care plans (ACP) provide patients the opportunity to communicate their goals and wishes for future care. LOCAL PROBLEM: A retrospective case note review of 50 inpatient deaths in 2017 confirmed a doctor had discussed expected death in 90%, however only 2% had an ACP. METHODS: Patients appropriate for ACP were identified on a single geriatrics ward. Interventions were implemented with monthly data collection. Patients with an ACP were followed prospectively. The initiatives were subsequently applied across six geriatrics wards. INTERVENTIONS: Interventions included improved identification of patients appropriate for ACP, doctor education and improved communication to general practitioners and healthcare providers. RESULTS: Before initiation of interventions on the pilot ward, ACP was completed for 38% of appropriate patients; this increased to a mean of 78.6% over 4 months post-interventions. During the pilot, 44 patients had an ACP. Of those discharged, 75% avoided readmission over the following 6 months. After applying the interventions across all geriatric wards, ACPs increased to a mean of 81.2% and was maintained 12 months later at 72%. CONCLUSIONS: The initiatives formed a structure to promote the use of ACP on the wards. Care plans focused on individualising care and effective communication resulted in reduction of readmissions.