Hospitalized patients and their families are often unprepared regarding end-of-life care. Even patients with high risk of mortality within the index admission or 30 days after admission often do not have clearly defined goals of care. This lack of clarity can create difficult scenarios for patients, their families, and care providers. Lack of communication and documentation of these goals can lead to unnecessary tests, procedures, and readmissions. By creating advanced care planning education for the hospital medicine department, a standardized note template, and EMR utilization for storage and reference of patient's goals of care documentation we aim to facilitate the conveyance of patient's wishes/preferences across different care providers and across separate encounters within the healthcare system. For this study, we will use a pre-post study design to evaluate the implementation of this quality improvement intervention.
Study Type
OBSERVATIONAL
Enrollment
743
Goals of care discussion with patient, documentation with electronic health record note and advance care planning billing. This will also include: pharmacy review of medications, case management review, and coding specialist review.
Duke University
Durham, North Carolina, United States
Proportion of patients who have advanced care planning notes completed during the admission
As measured by medical record review (Pre-implementation)
Time frame: Hospital admission, up to 7 days
Proportion of patients who have advanced care planning notes completed during the admission
As measured by medical record review (Post-implementation)
Time frame: Hospital admission, up to 7 days
Proportion of patient who have documentation utilizing the electronic health record dotphrase note template
As measured by medical record review (Pre-implementation)
Time frame: Hospital admission, up to 7 days
Proportion of patient who have documentation utilizing the electronic health record dotphrase note template
As measured by medical record review (Post-implementation)
Time frame: Hospital admission, up to 7 days
Proportion of patients who are billed for advanced care planning
As measured by medical record review (Pre-implementation)
Time frame: Hospital admission, up to 7 days
Proportion of patients who are billed for advanced care planning
As measured by medical record review (Post-implementation)
Time frame: Hospital admission, up to 7 days
Proportion of patients who receive palliative care consults
As measured by medical record review (Pre-implementation)
Time frame: Hospital admission, up to 7 days
Proportion of patients who receive palliative care consults
As measured by medical record review (Post-implementation)
Time frame: Hospital admission, up to 7 days
Proportion of patients who are discharged to hospice
As measured by medical record review (Pre-implementation)
Time frame: Hospital discharge, up to 7 days
Proportion of patients who are discharged to hospice
As measured by medical record review (Post-implementation)
Time frame: Hospital discharge, up to 7 days
Proportion of patients who have an appointment to the palliative care clinic
As measured by medical record review (Pre-implementation)
Time frame: Up to 1 month
Proportion of patients who have an appointment to the palliative care clinic
As measured by medical record review (Post-implementation)
Time frame: Up to 1 month
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