Advanced care planning (ACP) can empower patients to make decisions about their care according to their values and preferences. To improve the rate of advance care planning referral amongst inpatients admitted to the Department of internal medicine. 164 inpatients were referred for ACP discussion in a 12 month period in 2019 but only 7 patients successfully completed their ACP following an inpatient referral. The goal of this quality improvement project was to improve rates of referral and completion of ACP.

Methods Awareness amongst physicians was identified as a key factor limiting referrals and advocacy for advance care planning. Efforts was driven towards advocacy at the ward level. In this pilot project, efforts were made at educating doctors via department meetings of referral workflow and encouraging completion of ACP on the ward.

Results 72 referrals for advance care planning with were received over 4 month duration, with 7 completed from December 2020- March 2021 as compared to 46 referrals and 1 completed ACP during a similar time frame in Dec 2019-March 2020. At the point of data collection in April 2021 there were 60 referrals who were pending follow up in the outpatient setting

Conclusions Understanding and exposure to ACP is still growing. Opportunities need to be opened up for training physicians as ACP facilitators and ACP advocates. Pathways are required to ensure continuity of discussions initiated in the inpatient to the outpatient setting to follow up on patients who have been referred for ACP.