Background The national Advance Care Planning (ACP) programme was introduced in Singapore General Hospital (SGH) in 2013. While ACP referral rate within SGH increased, its completion rate remains low. Strategically, SGH ACP Workgroup was created in 2019 to strengthen ACP adoption and completion. This paper features two system enhancements; integration of ACP referral in Computerised Physician Order Entry (CPOE) system and adaptation of ACP documentation template in Sunrise Clinical Manager (SCM).
Methods SGH ACP workgroup consists of an interprofessional team of 17 doctors, one nurse and two allied health professionals, with secretariat support from Division of Medicine. Through ground engagement and review of work processes, the workgroup identified barriers contributing to inappropriate ACP referrals and low adoption by clinicians. With support from hospital leadership, the workgroup adapted CPOE from Seng Kang General Hospital, and mandated ACP advocacy by clinician prior to referral. Furthermore, to encourage bite-size ACP conversations and documentation by clinicians, the workgroup adapted ACP Clindoc template from Changi General Hospital.
Results Since the implementation of ACP system enhancements in September 2021, there is 10% increase in advocated referrals. 29% of total referrals are made through CPOE, while remaining referrals are made via existing referral platform which is estimated to cease in 2023. Within 826 ACP documentations submitted in Clindoc, 122 documentations were for completed ACP. These documentations were submitted by the ACP team, six doctors, 15 nurses and three MSWs.
Conclusions Positive results from both system enhancements suggest reduction in inappropriate ACP referrals through advocacy and increased ACP conversations and documentations by clinicians. Nevertheless, more can be done to capitalise on these enhancements as only a handful of clinicians have started using the systems. ACP workgroup will continue to engage in targeted hospital-wide roadshows and webinars to engage clinicians on these enhancements and collect feedback for further improvement.
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