Project to improve storage, access and incorporation of advance care plans in a regional Australian hospital

Auret, Kirsten; Sinclair, Craig; Wilkinson, Anne; Thomas, Jill C.; Price, Dot

doi:10.1111/ajr.12467

Cited by 8 publications

(7 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To illustrate, a recent Australian study demonstrated how a relatively simple intervention involving new clerical processes, minor modifications to the electronic patient administration system and clinician education markedly improved the number, accessibility, and recognition of ACP documents within a regional public health service. 36 Our findings also suggest there is an opportunity for system-level improvements to support the accessibility of ACP documentation in Australian health services. Given the current variability in systems for storing, retrieving, and accessing ACP documentation in Australia, 22 the use of a centralized e-health record system may improve the availability, transferability, and secure storage of ACP documentation.…”

Section: Discussionmentioning

confidence: 62%

Concordance Between Self-Reported Completion of Advance Care Planning Documentation and Availability of Documentation in Australian Health and Residential Aged Care Services

Buck

Detering

Pollard

et al. 2019

Journal of Pain and Symptom Management

Self Cite

View full text Add to dashboard Cite

Context. Advance care planning (ACP) documentation needs to be available at the point of care to guide and inform medical treatment decision-making.Objective. To examine concordance between self-reported completion of ACP documentation and self-reported storage of the documentation at the person's current point of care with the availability of the documentation in that person's health record.Methods. A national multicenter audit of health records and a self-report survey of eligible audit participants in 51 Australian health and residential aged care services. The audit assessed availability of ACP documentation in the health record, whereas the survey assessed self-reported completion and storage of the ACP documentation at the person's current place of care. To ascertain concordance, survey and audit data were cross-tabulated and concordance rates and kappa statistics were calculated overall and by health care sector and ACP documentation type.Results. The audit included 2285 people, of whom 1082 were eligible for the survey. Of 507 who completed the survey (response rate ¼ 47%), 272 (54%) reported completing ACP documentation, of whom 130 (48%) had documentation identified in the audit. Conversely, 39 of 235 people (17%) who reported not completing ACP documentation had documentation identified (concordance rate ¼ 64%; k ¼ 0.303, P <.001). The concordance rate increased to 79% when self-reported storage of ACP documentation at the person's current point of care was compared with the existence of the document in their health record (k ¼ 0.510, P < .001). Concordance varied by health care setting and type of ACP documentation.Conclusion. Discrepancies exist between self-reported completion of ACP documentation and the presence of these documents in the health records of older adults, representing a significant patient safety issue. Public education campaigns and improvements to systems for document storage and accessibility are required to support person-centered medical and end-of-life care. J Pain Symptom Manage 2019;58:264e274. Ó

show abstract

Section: Discussionmentioning

confidence: 62%

Concordance Between Self-Reported Completion of Advance Care Planning Documentation and Availability of Documentation in Australian Health and Residential Aged Care Services

Buck

Detering

Pollard

et al. 2019

Journal of Pain and Symptom Management

Self Cite

View full text Add to dashboard Cite

show abstract

“…Electronic medical records systems with functionality in communicating ACD documentation between healthcare settings play an important role in ensuring concordance between preferred and actual care. 30 Telehealth approaches may help in overcoming barriers to inclusive, family based ACP discussions due to physical distancing and limitations on visitation. 31 This rapid health system and community capacity building (particularly in the area of video-conferencing) will likely have permanent impacts on healthcare delivery, including opportunities to improve ACP for people with chronic diseases and those living in rural and remote areas.…”

Section: Leveraging Societal Changementioning

confidence: 99%

Advance care planning in Australia during the COVID‐19 outbreak: now more important than ever

Sinclair

Nolte

White

et al. 2020

Internal Medicine Journal

Self Cite

View full text Add to dashboard Cite

The novel Coronavirus disease 2019 (COVID‐19) outbreak has led to rapid and profound changes in healthcare system delivery and society more broadly. Older adults, and those living with chronic or life‐limiting conditions, are at increased risk of experiencing severe or critical symptoms associated with COVID‐19 infection and are more likely to die. They may also experience non‐COVID‐19 related deterioration in their health status during this period. Advance care planning (ACP) is critical for this cohort, yet there is no coordinated strategy for increasing the low rates of ACP uptake in these groups, or more broadly. This paper outlines a number of key reasons why ACP is an urgent priority, and should form a part of the health system's COVID‐19 response strategy. These include reducing the need for rationing, planning for surges in healthcare demand, respecting human rights, enabling proactive care coordination and leveraging societal change. We conclude with key recommendations for policy and practice in the system‐wide implementation of ACP, to enable a more ethical, coordinated and person‐centred response in the COVID‐19 context.

show abstract

“…National registries and health records, such as the National Health Service Digital in the United Kingdom or My Health Record in Australia, may assist in bridging this gap in communication [ 29 , 30 ] but as at March 2020, the number of ACP documents uploaded to My Health Record was 0.11% (26,920/22,740,000) [ 31 ]. Within countries, there are inconsistencies in where and how ACP documents are stored within electronic health records [ 32 – 34 ]. Electronic record system alerts can be used to inform hospital staff that a patient file includes an ACP document [ 34 , 35 ].…”

Section: Introductionmentioning

confidence: 99%

“…Within countries, there are inconsistencies in where and how ACP documents are stored within electronic health records [ 32 – 34 ]. Electronic record system alerts can be used to inform hospital staff that a patient file includes an ACP document [ 34 , 35 ]. Defining this ‘missing link’ in the ACP process may assist in more people’s preferences being known and respected during end-of-life care.…”

Section: Introductionmentioning

confidence: 99%

Communication of advance care planning decisions: a retrospective cohort study of documents in general practice

et al. 2020

View full text Add to dashboard Cite

Background: Doctors, particularly general practitioners, play a significant role in assisting patients to create advance care plans. When medically indicated, these documents are important tools to promote congruence between endof-life care and patient's personal preferences. Despite this, little is known regarding the availability of these documents in hospitals. The aim of this study was to identify the proportion of people who died in hospital without an advance care plan and how many of these had advance care planning (ACP) documents in their general practice records. Methods: A retrospective cohort study was conducted of patient hospital records with manual linkage to general practice records. The large regional hospital in Victoria, Australia has a catchment population in excess of 300,000 people. The study sample was patients aged 75 years and over who died in the hospital between 1 January 2016 and 31 December 2017. The hospital records of these patients were examined to identify those which did not have a system alert for ACP documents on the file. Alerted ACP documents were limited to those legislated in the state of Victoria: advance care plan, Enduring Power of Attorney (Medical Treatment) or Enduring Power of Guardianship. Where no ACP document system alert was found in the hospital record, the patient's nominated general practice was consented to participate and the corresponding general practice record was examined. Data were analysed using descriptive statistics. Results: Of the 406 patients who died in hospital, 76.1% (309) did not have a system alert for any ACP document. Of the 309 hospital records without a system alert, 144 (46.7%) corresponding general practice records were examined. Of these, 14.6% included at least one ACP document, including four advance care plans, that were not available in hospital. Conclusions: Unless ACP documents are consistently communicated from general practice, patient's preferences may be unknown during end-of-life care. It is important that both doctors and patients are supported to use connected electronic health records to ensure that documents are readily available to healthcare staff when they are required.

show abstract

Project to improve storage, access and incorporation of advance care plans in a regional Australian hospital

Cited by 8 publications

References 11 publications

Concordance Between Self-Reported Completion of Advance Care Planning Documentation and Availability of Documentation in Australian Health and Residential Aged Care Services

Concordance Between Self-Reported Completion of Advance Care Planning Documentation and Availability of Documentation in Australian Health and Residential Aged Care Services

Advance care planning in Australia during the COVID‐19 outbreak: now more important than ever

Communication of advance care planning decisions: a retrospective cohort study of documents in general practice

Contact Info

Product

Resources

About