TY - JOUR
T1 - Sustainability of a Multifaceted Intervention to Improve Surrogate Decision Maker Documentation for Hospitalized Adults
AU - Luty, Jacob
AU - Waagmeester, Garrett
AU - Ketterer, Briana
AU - Atluru, Sreevalli
AU - Toney, Keane
AU - Love, Michael
AU - Devane, Kenneth
AU - Sallay, Scott
AU - Diveronica, Matthew
N1 - Publisher Copyright:
© 2022 SAGE Publications Inc.. All rights reserved.
PY - 2022/11/1
Y1 - 2022/11/1
N2 - Documenting surrogate decision makers (SDMs) is an important step in advance care planning (ACP) for hospitalized adults. The authors performed a quality improvement study of clinical and electronic health record (EHR) workflows aiming to increase SDM documentation for hospitalized adults. The intervention included an ACP education module, audit and feedback, as well as workflow and EHR adaptations. The authors prospectively tracked SDM documentation using control charts and used chart review to assess secondary outcome, process, and balancing measures. SDM documentation significantly increased from 69.5% to 80.2% (P < 0.001) for intervention patients, sustained over 3 years, and was unchanged for control patients (34.6% to 36.3%; P = 0.355). There were no significant differences in secondary ACP outcomes in intervention or control patients. Clinical and EHR adaptations increased SDM documentation for hospitalized adults with minimal risk, although did not affect other ACP metrics. Future studies are needed to determine the effects of such changes on goal-concordant care.
AB - Documenting surrogate decision makers (SDMs) is an important step in advance care planning (ACP) for hospitalized adults. The authors performed a quality improvement study of clinical and electronic health record (EHR) workflows aiming to increase SDM documentation for hospitalized adults. The intervention included an ACP education module, audit and feedback, as well as workflow and EHR adaptations. The authors prospectively tracked SDM documentation using control charts and used chart review to assess secondary outcome, process, and balancing measures. SDM documentation significantly increased from 69.5% to 80.2% (P < 0.001) for intervention patients, sustained over 3 years, and was unchanged for control patients (34.6% to 36.3%; P = 0.355). There were no significant differences in secondary ACP outcomes in intervention or control patients. Clinical and EHR adaptations increased SDM documentation for hospitalized adults with minimal risk, although did not affect other ACP metrics. Future studies are needed to determine the effects of such changes on goal-concordant care.
KW - advance care planning
KW - electronic health record
KW - quality improvement
KW - surrogate decision maker
UR - http://www.scopus.com/inward/record.url?scp=85141005441&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85141005441&partnerID=8YFLogxK
U2 - 10.1097/JMQ.0000000000000081
DO - 10.1097/JMQ.0000000000000081
M3 - Article
C2 - 36149834
AN - SCOPUS:85141005441
SN - 1062-8606
VL - 37
SP - 495
EP - 503
JO - American Journal of Medical Quality
JF - American Journal of Medical Quality
IS - 6
ER -