Advance Care Planning in an Urban Hospital: Sustainability and Growth in Documenting Care Plans over Four-Years
Khadeja Kausar, Edward Coffield, Sampath Gopalan, Regina Tarkovsky, Sarah Egan, Robert A Press, John MarshallBackground
Advance 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.
Objective
To 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.
Methods
The 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.
Results
The 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 (
Conclusion
The growth and sustainability of the hospital’s ACP program demonstrates that barriers to ACP within hospitals can be overcome and successful programs implemented.