Advance Care Planning in an Urban Hospital: Sustainability and Growth in Documenting Care Plans over Four-Years

BackgroundAdvance care planning (ACP) aligns treatment pathways with patient preferences. Many acute care patients are admitted without advance care plans (AC-Plans) which may result in patients receiving care misaligned with their preferences. Accordingly, ACP is needed within hospitals, however, implementation barriers exist.ObjectiveTo evaluate an ACP program developed by a 711-bed hospital to overcome many of the barriers to implementing hospital-based ACP. Success was measured as the percentage of patients with AC-Plans at discharge over the four-year study.MethodsThe hospital's ACP program components included: primary palliative care, simulation-based training, and ACP and AC-Plan training and education. The sample consisted of patients aged 65 years and older who were admitted without documented AC-Plans, at the hospital, between November 1st 2021 to October 31st 2025. Primary evaluations consisted of examining yearly trends in the percentage of patients with AC-Plans at discharge with Kendall's tau and testing association between admission year and the likelihood of having an AC-Plan at discharge with a logistic regression.ResultsThe sample consisted of 25,189 patients. The percentage of patients with ACPs at discharge increased from 4.4% to 19.1% from the first to fourth program year. The odds of having an AC-Plan at discharge in years 2, three, and four were 3.44 (P < 0.001), 5.87 (P < 0.001), and 8.97 (P < 0.001) times higher than the odds of having one during the first program year.ConclusionThe growth and sustainability of the hospital's ACP program demonstrates that barriers to ACP within hospitals can be overcome and successful programs implemented.