Exploiting Technology to Popularize Goals-of-Care Conversations and Advance Care Planning

Area of Science:

• Medical Informatics
• Patient-Centered Care
• Critical Care Medicine

Background:

• Goals-of-care conversations are crucial for patient-centered care but often delayed until critical illness.
• Current practices show inconsistent and delayed engagement in these vital discussions.

Purpose of the Study:

• To evaluate the frequency and quality of goals-of-care conversation documentation in intensive care unit (ICU) deaths.
• To develop and implement strategies for enhancing the quantity and quality of these conversations.

Main Methods:

• A retrospective review of ICU deaths identified barriers to goals-of-care conversations.
• An inter-professional task force developed solutions, including a dedicated EHR tab and SmartPhrase template.
• Nurses and physicians received education to promote documentation of these conversations.

Main Results:

• Before the intervention, EHR documentation was inconsistent and conversations occurred late in patient care.
• Three years post-implementation, the dedicated EHR tab was used for 75% of hospital deaths.
• Sixty-seven percent of goals-of-care conversation notes utilized the standardized SmartPhrase template.

Conclusions:

• Electronic health record (EHR) platforms can effectively increase the frequency and improve the quality of goals-of-care conversations.
• Standardized processes and user-friendly tools can cultivate a culture of advance care planning.
• Integrating structured documentation into EHRs is key to enhancing end-of-life care discussions.