|Picture of this frog has no bearing on the post. I'm not saying residents are frogs in disguise. Seriously. It's just a cool picture, isn't it? Credit Wikimedia Commons|
On the other hand, hospital admission to a medicine service is one of the few times critical advance care planning conversations occur. This represents a major opportunity to communicate with patients about their goals, values, and preferences for end-of-life care. Unfortunately, even when these conversations take place, the medical residents sometimes do not document this information in the medical record or discharge summary in a place where it is clearly accessible for future clinicians.
In that context, Josh Lakin and colleagues at UCSF created a remarkable incentive program for residents to document advance directives in the chart. The study was just published in JAMA Internal Medicine. They set a goal of increasing documentation of the following for hospiatlized patients: 1) wishes for care 2) identification of health care proxy.
The intervention consisted of
- A discharge summary template with these fields
- A financial incentive ($400 for each resident if the entire program achieved a 75% documenationa rate)
- Feedback about each resident and admitting team was doing emailed out to all the teams biweekly
- Rates of documentation improved from 22% to more than 90% at the end of the year
- In a comparison group of a hospitalist-only service (no residents) who had the template but no financial incentive or feedback mechanism, rates stayed constantly low throughout the year.
by: Alex Smith