- 1.Identify appropriate patients to discuss advance care planning in outpatient setting.
- 2.Illustrate barriers to having these discussions through the PDSA process.
The Veteran’s Affairs (VA) healthcare system recently implemented the Life Sustaining Treatment (LST) Plan to promote a patient-centered approach to end-of-life decisions. Unfortunately, a majority of these conversations occur in the inpatient setting when patients are acutely ill.
We sought to improve LST completion rates in the outpatient setting by 20% since implementation through resident and patient driven interventions over 6 months.
Patients with CAN scores greater than 90 in one clinic were identified. Patients who had a completed advance directive were excluded, and baseline LST completion rate was calculated. Our first intervention included an email notification to providers identifying patients with CAN scores greater than 90. Our second intervention involved distributing LST brochures while patients were waiting for their appointment.
We identified 185 patients with CAN scores greater than 90 in this clinic. Sixty patients were excluded because of completed advance directives. Mean CAN score was 93.2 + 3.6. Two out of 125 patients had LST completed in the outpatient setting, for a baseline rate of 1.6%. Following our resident driven intervention, one LST was completed in the outpatient setting with a completion rate of 0.9% (1/110). Our subsequent patient driven intervention did not yield any further completion of the LST form.
Conclusions and Implications
Neither the provider nor patient driven interventions improved LST completion rates. Completing LST documentation has proven difficult in the outpatient setting, likely due to time constraints in clinic. The LST form is still new to the outpatient setting, and more education is needed for both patients and staff regarding its components. Increasing completion of LST will likely require further interdisciplinary coordination.
© 2021 Published by Elsevier Inc.