Background There has been increasing focus in improving care for the elderly as the population in Singapore ages. Advance care planning (ACP) is an effective way in improving the quality of life especially in the frail elderly. Review of published literature has shown a large discrepancy in the proportion of elderly patients who are keen to do ACP versus the number of ACP facilitation that is done. One barrier is the lack of opportunity to discuss ACP as there are other competing acute medical issues. Other literature has also shown that increasing frailty and a change in social circumstances such as transitioning to a long-term care facility are common catalysts for initiating ACP discussions.
Methods In this quality improvement project, we targeted patients under General Medicine who are admitted in the subacute wards. A prompt to ask if ACP is appropriate was added in the screening checklist before the patients are transferred to the subacute wards. All patients who are already admitted in the subacute wards are also screened for frailty and ACP discussion is offered to those who score 7 and above in the Clinical Frailty Score (CFS).
We reviewed the number of ACP facilitation in the subacute ward for the period of 2017–2019. We have excluded the numbers after 2019 as the subacute wards were closed during the COVID-19 pandemic.
Results The number of ACP facilitations increased from 20 in 2017 to 61 and 73 for 2018 and 2019, respectively. Our experience has shown that the number of ACP discussion has increased significantly and remained sustained after 2 years.
Conclusion The number of ACP facilitation can be improved amongst frail and elderly by increasing the opportunities for ACP discussions. This can be achieved by incorporating simple prompts in existing work processes.
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