Walker Laura E, Liwonjo Anne, Goyal Deepi G
Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
Hospital Medicine, Mayo Clinic Health System Albert Lea, Albert Lea, Minnesota, USA.
BMJ Open Qual. 2025 Jan 6;14(1):e002703. doi: 10.1136/bmjoq-2023-002703.
Understanding patients' wishes and preferences during hospitalisation is a crucial component of care. We identified a gap related to documentation of advance directives and patient preferences for care and focused on ensuring appropriate goals of care discussions were occurring and documented. Our aim was to improve the documentation of advance care planning notes to include 80% of targeted hospitalised patients.
Hospitalised patients in two community hospitals were included. We performed serial Plan-Do-Measure-Act cycles. The first intervention introduced the 'surprise question' during an afternoon huddle. Intervention 2 emphasised documentation of the advance care planning note. The third intervention used a structured approach led by administrators at daily multidisciplinary huddles and identified patients with an Elderly Risk Assessment score of 16 or greater as targets for advance care planning documentation.
From a baseline performance under 10%, we increased to greater than 80% of patients with Elderly Risk Assessment scores of 16 or higher having documented advance care planning. We were able to sustain this performance over subsequent years.
A structured approach that identifies a targeted population at higher risk of mortality, and implementation of a checklist at a daily multidisciplinary huddle provided sustained improvement in advance care planning documentation. This provides the opportunity for improved patient care that is aligned with their values and preferences.
了解患者住院期间的意愿和偏好是护理的关键组成部分。我们发现预先指示和患者护理偏好的记录存在差距，并专注于确保进行并记录适当的护理目标讨论。我们的目标是将预先护理计划记录改进到覆盖80%的目标住院患者。
纳入两家社区医院的住院患者。我们进行了一系列的计划-执行-测量-行动循环。第一次干预是在下午的碰头会上引入“意外问题”。干预2强调预先护理计划记录。第三次干预采用由管理人员在每日多学科碰头会上主导的结构化方法，并将老年风险评估得分16分或更高的患者确定为预先护理计划记录的目标对象。
从低于10%的基线水平，我们将老年风险评估得分16分或更高且有预先护理计划记录的患者比例提高到了80%以上。在随后几年中，我们能够维持这一水平。
一种识别死亡风险较高的目标人群的结构化方法，以及在每日多学科碰头会上实施检查表，使得预先护理计划记录得到持续改善。这为根据患者价值观和偏好改善患者护理提供了机会。
