Impact of a Comprehensive End of Life Admission Order Set On Clinician Self-Rated Care Proficiency

High-quality end-of-life (EOL) care is essential to ensure comfort, dignity, and goal-concordant care. Despite its importance, variability in practice and clinician-reported challenges with preparedness and guidance persist. Electronic health record (EHR) based order sets may standardize EOL care, but their impact across settings is not well defined.

Assess the impact of a comprehensive order-set on provider proficiency with EOL care.

Clinician perceptions of satisfaction with EOL guidance, preparedness for care delivery, and ease of order process were assessed pre-and post-implementation of an electronic EOL admission order set at St. Jude Children's Research Hospital. Comparison between baseline (T1) and post-implementation (T2) responses used chi-square or Fisher's exact tests and ordinal logistic regression. McNemar's test, Stuart-Maxwell test, and mixed‑effects ordinal logistic regression were utilized for retrospective response analysis.

A total of 340 survey responses were analyzed (T1:n=197; T2:n=143). Implementation was associated with significant improvements in satisfaction with EOL guidance among prescribers (including physicians and advanced practice providers) (very satisfied:10.9% → 33.9%, p=0.004) and nurses (7.1% → 19.7%, p=0.028). Nurses reported substantial increases in preparedness (very prepared:14.2% → 53.0%, p<0.001). Prescribers reported greater ease in placing and following EOL orders (OR=2.81; 95% CI:1.82-4.37; p<0.001). Retrospective assessment at T2 demonstrated higher satisfaction after implementation than before (OR=2.39; 95% CI:1.44-3.97; p=0.001). Improvements were consistent across roles and experience levels.

Implementation of a standardized EOL admission order set can improve clinician reported satisfaction, perceived preparedness, and workflow efficiency in EOL care processes, which may result in enhanced EOL care delivery.