1292 A glimpse of success: early achievements in advance care planning completion rate for CKD patients with high potential for growth
Year: 2025
Type: conference-paper
Abstract: Background and Aim This QI initiative, with the aim to increase the completion rate of referred ACP discussions from the current 50% to 80% within a six-month period, was conducted in the Low Clearance Clinic (LCC), National University Hospital. The LCC functions provide specialized care for patients with advanced CKD and ESKD. The target patient group includes individuals diagnosed with eGFR <20 mL/min, and ages above 60 years old. ACP discussions, where Goals of Care (GoC) are explored and documented, are strongly encouraged. Problem Identified Patients and families lacked readiness to discuss GoC Patients at LCC were aged 60 and above, and they indicated preference to have their families to be present during ACP discussion Patients often deprioritize ACP if they are not conducted on the same day as their follow-up appointment Key Actions Introduced Doctors and nurses will introduce and counsel both patients and their families about GoC, emphasizing the importance of discussing and documenting their personal values, life goals, and medical treatment preferences Patients and families will then be informed that ACP Care Coordinators will facilitate the GoC documentation at the next follow-up appointment Encourage involvement of the families of patients, given that the target patient group is elderly Patients and families who demonstrate readiness to engage in ACP discussions will be labelled as ‘ACP Ready’ in the EMR, at least one week before their follow-up appointment This informs ACP Care Coordinators in advance, and allows allocation of adequate manpower accordingly This seamless same-day transition aimed to minimise patient loss, reduce drop-off rates, and improve ACP completion Early Results and Observations Following the implementation at LCC, we observed: ACP completion rate has achieved a stunning 100%, representing a 2-fold improvement over the hospital-wide baseline of 50% Time taken per ACP discussion has reduced to an average of 45–60 minutes, reflecting a 50% efficiency gain Lessons Learned Engagement of patients and families is key as the latter is often double hatting as the caregivers Seamless integration into existing workflows is to minimise adjustments, making them easy to adopt with minimal disruption, ensuring smoother transitions and higher acceptance from healthcare teams Effective use of healthcare resources and enhancing quality of care Impact for the Healthcare System as a Whole A replicable model that can be adopted by other institutions, enhancing overall care quality
Source: Poster
Authors: Angie Lim, Pei Si Koh, Allison Chua, Yvonne Loo, Jimmy Teo
Institution: National University Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4414088998