Enhancing POLST Completion in a Hospital Setting: An Interdisciplinary Approach | JoVE Visualize

Area of Science:

Healthcare Quality Improvement
Geriatric Medicine
Palliative Care

Background:

Increasing numbers of patients with multiple comorbidities are living longer, often experiencing recurrent hospitalizations and interventions misaligned with personal goals.
Advance directives and Physician Orders for Life-Sustaining Treatment (POLST) are crucial for ensuring goal-concordant care, especially for those with serious progressive illnesses, Do Not Attempt Resuscitation (DNAR) orders, or advanced dementia.
Hospital discharge planning presents a key opportunity for completing these vital advanced care planning documents.

Purpose of the Study:

To implement and evaluate a quality improvement initiative aimed at increasing POLST completion rates for specific high-risk patient populations.
To integrate POLST completion into interdisciplinary care rounds and hospital discharge processes.
To expand advanced care planning to include patients with newly diagnosed high-mortality cancers.

Main Methods:

A quality initiative was launched at an 896-bed academic medical center to facilitate POLST completion for patients discharged with DNAR status or dementia to skilled nursing facilities.
Emphasis was placed on POLST completion during interdisciplinary progression of care rounds, with proactive, facilitated discussions involving patients, families, and physicians.
Completed POLST forms were uploaded to the electronic health record, and regular feedback was provided to units and physicians on completion rates.

Main Results:

POLST completion rates for DNAR patients discharged alive increased from 41% in FY 2014 to 75% in FY 2019.
For patients with dementia discharged to skilled nursing facilities, POLST completion rates rose from 14% in FY 2014 to 54% in FY 2019.
The initiative's success led to expanded efforts for patients with high-mortality cancers, focusing on advanced care planning and palliative care referrals.

Conclusions:

A structured quality improvement initiative effectively increased POLST completion rates for vulnerable patient populations during hospitalization discharge.
Integrating POLST completion into routine care processes and providing feedback enhances adherence to patient goals and preferences.
The program's success supports the expansion of proactive advanced care planning to broader patient groups, including those with newly diagnosed serious cancers.