Background Advance care planning (ACP) empowers Singaporeans to choose how they would like to be cared for and is a process of planning for current and future healthcare. Studies indicate that ACP enhanced patients’ sense of autonomy and satisfaction with care and benefited caregivers as they displayed improved psychosocial outcomes after the patients’ death. However, the uptake of ACP discussions remain low locally, with an estimated of only 10,000 ACP discussions completed in Singapore up to 2017. Hence the focus of this project is to contribute to the nationwide effort of increasing ACP discussions for Singaporean residents who are ready for such discussions, and to pace with those who are not.

Measures We focused our efforts on a specific group of frail patients, defined as Clinical Frailty Scale(CFS)≥6. Our main outcome measure is to conduct completed ACPs in 20% of this target population. We considered process measures such as the percentage of target population with an ACP discussion initiated, the percentage of completed ACP on Clindoc uploaded onto AIC, and the percentage of staff trained in general ACP or PPC (Preferred Plan of Care) or both. Our balancing measures included measuring the percentage of staff who found that time spent on doing ACP impeded upon other clinical duties, the percentage of patients or next-of-kin distressed with ACP discussion, and the percentage of staff who found ACP discussion challenging.

Planned intervention(s) The first PDSA involved creating a standardized workflow to identify the target population, conduct the ACP discussion and upload it onto the AIC portal. The other interventions we will be carrying out would target staff engagement and patient and next-of-kin engagement change ideas.

Conclusion We hope to streamline the process of conducting ACPs in the community hospital setting and implement and spread the efforts to other community hospitals in Singapore.