Background and Aims The National Healthcare Group (NHG) River of Life framework is our blueprint of care continuum to live well through 5 care segments. One main challenge of Singapore’s aging population is with lifelong care - living with frailty and leaving well with advance care planning (ACP). ACP has many positive outcomes, including reduced hospitalisation and healthcare utilisation cost. Frailty is a key driver of healthcare cost which makes it crucial to address ACP in the frail elderly patients.
This project aims to create awareness of ACP and frailty within Geriatrics Medicine (GRM) department; and to improve ACP completion rate of GRM patients in 2 GRM wards with Clinical Frailty Scale (CFS) ≥ 7.
Methods Reasons why ACP is not completed in the GRM wards were evaluated through root cause analysis. Plan-Do-Study-Act cycle was used to propose changes and improvement. We analysed the issues at levels of staff, process, equipment, patient/family and environment (Table 1).
Results Figure 1 illustrates the ACP completion rate in 2 GRM wards with time. Data was collected on a 2-weekly basis. The ACP completion rate showed a steady increase with time and intervention. It peaked at 77.8% and the mean rate was 60.9%, compared to pre-intervention rate of 27%.
Sustainability and Project Impact The main outcome is to improve ACP completion rate; the secondary outcome is to train and identify frail patients using CFS, which enhances NHG frailty framework in integrating ACP into care plans.
Staff are continually trained to facilitate ACP. CFS is incorporated into electronic clerking notes and ACP office is continually monitoring the completion rate. This work has expanded to other wards too.
Conclusion This project fulfills its objectives of creating ACP awareness and frailty within GRM department and improving ACP completion rate of our frail elderly.
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