Enhancing POLST Completion in a Hospital Setting: An Interdisciplinary Approach

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.