Hawaii has been identified as a state with very high end of life hospitalisation rates and associated costs. We have had a POLST law in effect since July 2009, but in spite of multiple educational forums we found low levels of awareness. We also found that our frontline staff did not have easy access to documents indicating patient wishes around end of life when they were provided to us, placing our patients at risk for not having their wishes followed. We created a program to address these needs. We adopted the Respecting Choices program and provided Advance Care Planning training to appropriate staff at each of our 4 hospitals. We also invited participation from long term care facilities that receive and send us patients. We also created online training modules for frontline clinicians to understand the program. At the same time, we worked to ensure that ACP documents are immediately available in our electronic medical record, so that as patients access care, we are able to reliably view their documents. HPH partnered with Allina Hospital to improve the electronic medical record and worked with the medical records to improve the ACP scanned documents process. In addition, we identified groups of patients (both at time of hospital discharge and outpatients) for whom a POLST is likely to be appropriate and we worked to increase the number of POLST orders that were created with them.
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