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J Palliat Med. 2019 Feb 14. doi: 10.1089/jpm.2018.0419. [Epub ahead of print]

Improving Communication About Resuscitation Preference for Patients Discharged from Hospital to Nursing Home: A Quality Improvement Project.

Author information

1
1 Department of Medicine, University of Colorado School of Medicine, Denver, Colorado.
2
2 Department of General Internal Medicine, Denver Health and Hospital, Denver, Colorado.
3
3 Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California.
4
4 UCLA Health System, Los Angeles, California.
5
5 VA Greater Los Angeles Healthcare System, Los Angeles, California.

Abstract

BACKGROUND:

Physician Orders for Life-Sustaining Treatment (POLST) can help ensure continuity of do-not-resuscitate (DNR) decisions and other care preferences after discharge from the hospital.

OBJECTIVE:

We aimed to improve POLST completion rates for patients with DNR orders who were being discharged to a nursing home (NH) after an acute hospitalization at our institution.

DESIGN:

We implemented an interprofessional quality improvement intervention involving education, communication skills, and nursing and case manager cues regarding POLST use. The intervention was later augmented with performance feedback and financial incentives for resident physicians who completed a POLST at NH transfer.

MEASURE:

Whether patients with DNR orders at hospital discharge have a POLST at NH transfer.

RESULTS:

The intervention resulted in increased POLST use for patients with DNR orders discharged to NH: baseline 25/65 (38%), intervention 36/71 (51%), and augmented intervention 44/63 (70%) (pā€‰<ā€‰0.01).

CONCLUSIONS:

An interdisciplinary intervention can increase POLST use for patients with DNR orders transitioning to NH. Multiple components, including financial incentives and performance feedback, may be needed to effect statistically significant change.

KEYWORDS:

Physician Orders for Life-Sustaining Treatment; advance care planning; care transitions; communication; performance feedback; quality improvement

PMID:
30762475
DOI:
10.1089/jpm.2018.0419

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