Electronic Goals of Care Alerts: An Innovative Strategy to Promote Primary Palliative Care

Haley, Erin; Meisel, Deborah; Gitelman, Yevgeniy; Dingfield, Laura; Casarett, David; O’Connor, Nina

doi:10.1016/j.jpainsymman.2016.12.329

Cited by 15 publications

(20 citation statements)

References 22 publications

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“…As such, others have found that electronic medical record alerts, alongside clinician education, may provide a simple method to improve GOC completion. 15 Finally, confusion and greater comorbidities in patients 75 years and over were independently associated with a higher rate of proper completion of GOC forms. This may stem from the clinician's assessment of actual or anticipated deterioration during admission.…”

Section: Discussionmentioning

confidence: 96%

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Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Potenzi

Lim

2020

Internal Medicine Journal

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Background: The goals-of-care (GOC) form is a resuscitation planning tool used to document informed decisions tailored for individual patients admitted to hospital. Proper and timely completion of the GOC form is essential for its effective utility. Aims: To identify patient factors which may affect the timely discussion and documentation of GOC forms in patients admitted under a general medicine unit. Methods: We performed a cross-sectional study of 2589 patients during 3093 admissions under the general medicine unit from January 2017 to July 2017 at Dandenong Hospital in Melbourne, Australia. The main outcome was the proper completion of GOC forms, defined as GOC completion within 48 h of admission and adequate discussion with the patient or substitute decision maker. We used logistic regression to determine the association between the main outcome and several patient-related independent variables. Results: A GOC form was completed in 66% of all admissions but only 35% were considered properly completed (timely and adequately discussed). In the general multivariable logistic regression model, the variables associated with proper completion of GOC forms were age (OR = 1.58), English as the main spoken language (OR = 1.43) and readmissions (OR = 1.27). In patients 75 years and older, additional factors associated with proper GOC completion were confusion on admission (OR = 1.31) and number of comorbidities (OR = 1.27). Conclusions: The proper GOC form completion rates were suboptimal in general medicine admissions, particularly in younger patients with fewer comorbidities. Additional effort is needed to improve GOC completion in these patients and those whose primary spoken language is not English.

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Section: Discussionmentioning

confidence: 96%

“…At the time this study was conducted, we relied on scanned medical records rather than electronic medical records. As such, others have found that electronic medical record alerts, alongside clinician education, may provide a simple method to improve GOC completion 15…”

Section: Discussionmentioning

confidence: 99%

Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Potenzi

Lim

2020

Internal Medicine Journal

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“…Despite evidence that they significantly increase the rate of conversations, uptake of EHR-based alerts to perform SICs in high-risk patients has been slow. 4 Code status inconsistencies are pronounced periprocedurally. Despite surgical and anaesthesia guidelines recommending CSDs in patients with code status limitations ensuring goal-concordant care during and after procedures, adherence is inconsistent.…”

Section: (O) Order Entry Standardisationmentioning

confidence: 99%

“…Clinicians leading conversations are often untrained discussing the topic, under time constraints and concerned about conflicting with longitudinal providers. 4 Patients routinely do not receive clear resuscitation options at the appropriate literacy level and overestimate the chances of successful resuscitation. 5 Systems lack formal CSD training programmes, poorly implement guidelines and underuse electronic decision support shown to improve CSD documentation.…”

Section: Introductionmentioning

confidence: 99%

CODE: a practical framework for advancing patient-centred code status discussions

2020

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“…We are aware of only one other tool that approaches this conversation from a similar framework. 6 Models currently exist and have been studied for ''Breaking Bad News,'' [7][8][9][10][11] or having GOC discussions when a patient is in the terminal stage of their disease. [12][13][14][15] Education surrounding how to deliver bad news is integral to medical training; however, this skill set, in which one party is the ''giver'' of information and the other a ''receiver,'' is very different from a shared decision-making process making treatment decisions that are affected by personal values, goals, and preferences.…”

Section: Introductionmentioning

confidence: 99%

Feasibility and Effectiveness of a Mnemonic Approach to Teach Residents How to Assess Goals of Care

Ajayi

Shaw

Edmonds

2019

Journal of Palliative Medicine

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Background: Shared decision making is a collaborative process that allows patients, or their surrogates, and clinicians to make health care decisions together. There is an imperative to teach young physicians early in their training the importance of engaging in a shared decision-making process to define overall goals of care (GOC). The PERSON mnemonic proposes a structured format that allows providers to evaluate GOC across the spectrum of serious illnesses, outside of breaking bad news or end-of-life planning. Objectives: This study evaluated the utility of the PERSON mnemonic in training residents to have GOC with their patients, and investigated if these skills translated to the bedside with real patient encounters. Methods: First-year residents were divided into groups to participate in an in-depth education session. A pre-/ postbaseline survey was administered immediately after the education intervention and approximately seven months later to assess retention and utility. Results: Thirty first-year residents were eligible for this study; 30 attended the educational sessions and completed the immediate baseline pre-/postsurvey and the seven-month follow-up survey, resulting in 100% retention rate throughout study. Residents found sustained utility in the mnemonic. It was significantly successful in increasing the knowledge and confidence level in exploring GOC. Patient-centered outcomes could not be analyzed due to low response rates and limited granularity of hospital-level data. Conclusion: The PERSON mnemonic is a feasible and useful format for teaching residents how to have a GOC discussion.

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Electronic Goals of Care Alerts: An Innovative Strategy to Promote Primary Palliative Care

Abstract: The combination of brief education and electronic goals of care alerts significantly increased documented goals of care discussions. This intervention is simple and feasible in many settings, but larger studies are needed to determine impact on patient outcomes.

Cited by 15 publications

References 22 publications

Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

Patient factors affecting the proper completion of a goals‐of‐care form in a general medicine hospital admission

CODE: a practical framework for advancing patient-centred code status discussions

Feasibility and Effectiveness of a Mnemonic Approach to Teach Residents How to Assess Goals of Care

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