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Rapid Response to Inpatient Medical Power of Attorney Completion: A Dedicated Social Work Intervention During COVID-19 (QI706)

      Objectives

      • 1.
        Describe the design and implementation of a social work-led intervention to improve Medical Durable Power of Attorney completion for hospitalized patients during the COVID-19 pandemic.
      • 2.
        Illustrate the use of effective change management strategies.

      Background

      The high risk of mechanical ventilation with COVID-19 requires health care systems to innovate advance care planning (ACP) delivery for hospitalized patients to promote receipt of goal-concordant care.

      Aim Statement

      To increase the proportion of hospitalized patients with a Medical Durable Power of Attorney (MDPOA) form available in the electronic medical record (EMR) in parallel with the rising number of COVID-19 hospitalizations.

      Methods

      Human-centered design was used to develop a social work (SW) intervention. Care Managers were asked to routinely consult SW if there was no MDPOA form available in the EMR. Twenty-eight SWs staff our 650-bed hospital at a ratio of 1 SW to 36 patients. Change management strategies were chosen and tailored to address SW implementation barriers. Data was collected using an automated report in our EMR which identified a weekly list of hospitalized patients with an MDPOA. Analysis of the difference in proportion of patients each week with an MDPOA was done using a statistical process control p-chart.

      Results

      Weekly baseline data was collected from January 5–April 5, 2020. The intervention started April 12th and data were collected for 12 weeks. At eight weeks, the number of SW consults overwhelmed the inpatient SW team and the intervention was amended to focus on high-risk patients. Despite needing to focus the SW intervention on high-risk patients only, the baseline weekly average of hospitalized patients with an MDPOA increased from 30.1% patients to 42.8% after intervention implementation, with correlating evidence of special cause variation.

      Conclusions and Implications

      In anticipation of future surges of COVID-19 admissions, health systems need to implement effective ACP processes in the acute care setting. Change management strategies can rapidly address the needs of overwhelmed health systems and should focus on identifying staffing models that are effective and sustainable.