Background The Austin Hospital, a tertiary care university teaching hospital with 900 beds manages approximately 100, 000 inpatients and 170,000 outpatients per year. The ACP program began in 2002 and has evolved significantly. Initially the focus was on education of large numbers of staff, to assist them to undertake ACP as part of their usual work, and by doing so, to encourage and support patients to participate in ACP. This had minimal effect on the number of patients undertaking ACP.

Methods During 2008 an ACP facilitator role was developed, and since this time, the predominant provision of ACP has been by non-medical facilitators, (part-time staff, equivalent to 2 full-time positions) with an accumulated experience of providing ACP to over 6000 patients. Although elderly patients and those with poor prognoses are targeted, the service is available to all patients, including more recently, non-competent, and non-English speaking patients. Approximately 30% of patients complete Advance Care Directives, appointing substitute decision-makers, documenting wishes or both, and most conversations take less than 90 min in total. Key findings related to outcomes of ACP discussions will be presented.

Discussion The ACP facilitators also provide ACP education and support to hospital staff thereby assisting other staff to be involved in discussions with patients, and thereby improving access. This is important given the increasing need for ACP services at the hospital, and the expectation by government that ACP should be part of usual care, and is now included as part of hospital accreditation. These strategies will be discussed.