Honoring Patient Choices With Advance Care Planning

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Patients in Hawai’i are spending their dying days in the hospital and the intensive care unit. In Hawai’i, as of 2014, inpatient spending during the hospitalization in which death occurred was $5518, and US national average was $3802; 18.5% died in the intensive care unit compared with the US national average of 14.4%. Hawai’i has a high elder population who frequently have longer length of stays and are being readmitted to our facilities; 26.7% of deaths occur in Hawai’i hospitals versus the national average of 21.0% from 2003 to 2014. Furthermore, these patients are often not receiving the care that they would choose if informed of their options. The objective of this quality improvement project was to develop, implement, and evaluate the usefulness of an advance care planning (ACP) approach to assist clinicians in identifying and honoring patient choices. A target patient population (“Last Stages”) was identified for the project, and an ACP registry was created. Retrospective chart review showed that, for Last Stages patients, ACP documentation increased from 28.90% to 87.03%, and Provider Orders for Life-Sustaining Treatment completion rates rose from 12.89% to 53.90% after implementation of the ACP approach. Of the patients admitted to the hospital with Provider Orders for Life-Sustaining Treatment, 94% of these patients’ documented wishes were honored. Advance care planning processes did improve clinician adherence to patient choices, reducing the risk of patients receiving unwanted care.

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