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PP20.003 Increasing referrals for advance care planning discussions in a community hospital setting
  1. Sae Cheong Yap,
  2. Jesmine Lee,
  3. Jia Min Tee,
  4. Kuan Yew Yong,
  5. Siew Ting Sim,
  6. Li Lian Koh,
  7. Kelvin Koh and
  8. Norhisham Bin Main
  1. Jurong Community Hospital, Singapore, Singapore


Background Advance Care Planning (ACP) discussions allow patients to express their wishes with regards to end of life care. Initiating the ACP conversation is part of care for patients recovering from acute illness in our community hospital.

The number of referrals for ACP at baseline is low, averaging 16.7 patients per month over a period of 3 months from April to June 2022. This is in relation to a 259 inpatient bed service. of those referred, the eventual completion of ACP discussions averages 12.3 patients per month.

The objective of our quality improvement project was to increase both the number of referrals for ACP from our inpatient service as well as the number of completed ACP discussions by 100% over a period of 5 months from July to November 2022.

Methods Interviews were conducted with 4 clinicians, 2 allied health staff, 1 patient and 3 family members to identify barriers in referral for ACP. Our clinicians had low levels of recognition of ACP as an important aspect of care. This was identified as the most impactful factor on root cause analysis.

Our intervention comprised firstly education of our staff through lectures on ACP. Secondly, emails tracking the individual number of ACP referrals were sent to our staff on a monthly basis.

Results The number of referrals for ACP increased to an average of 47.6 patients per month (185.6% increase). The overall number of completed ACP discussions increased to an average of 28 patients per month (127% increase).

Conclusion Improving clinician awareness of ACP through simple measures like education and tracking of referral numbers is effective in increasing ACP discussions. Areas to focus on in future would include addressing patient and family factors to ensure more patients who are referred for ACP eventually complete their ACP discussion successfully.

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