Increasing Serious Illness Conversations in Patients at High Risk of One-Year Mortality Using Improvement Science: A...

Area of Science:

• Medical Education
• Quality Improvement
• Palliative Care

Background:

• Serious illness conversations (SICs) are crucial for aligning patient-centered outcomes with medical treatments.
• A review of mortality meetings revealed a need for earlier engagement in SICs and advance care planning (ACP).
• This study aimed to enhance SICs and their documentation in patients with poor prognosis.

Purpose of the Study:

• To increase the frequency and documentation of serious illness conversations (SICs).
• To identify patients with low one-year survival probability using updated Charlson Comorbidity Index (CCI) scores.
• To improve advance care planning (ACP) and patient-centered outcomes.

Main Methods:

• A quality improvement study was conducted at a level one trauma center.
• Integrated care managers identified and discussed high CCI scores during interdisciplinary rounds.
• Providers were encouraged to document SICs in extent of care (EOC) notes within the EPIC electronic health record.

Main Results:

• 16 out of 62 patients (25.81%) with high CCI scores had documented EOC notes.
• Patients with documented EOC notes were more likely to have palliative care (63.04%) and hospice consults (93.48%).
• Post-intervention, 50% of providers conducted SICs, but documentation in EOC notes remained suboptimal.

Conclusions:

• Documentation of SICs is associated with increased engagement in ACP, palliative care, and hospice consultations.
• This intervention shows promise in improving end-of-life care discussions and decisions.
• Further efforts are needed to enhance the documentation of SICs in electronic health records.