Background Singapore has a growing ageing population with an increase in chronic progressive illnesses. The need for advance care planning (ACP) has become increasingly important. It has been found that ACP is better accepted by the patient when offered by their doctor. Unfortunately, many institutions have struggled to get the main stakeholders involved.
Our aim was to integrate ACP into daily clinical practice- a systematic and sustainable model for ACP implementation in a general medical unit in an acute hospital, targetting the population who would most benefit from it.
Methods Implementation involved a three-pronged approach of promoting awareness, facilitator training and formal screening, using triggers- age >75 years, poor premorbid function and more than 3 recurrent admissions in a year. These triggers apply to our target group, and their simplicity makes it easy for clinicians to remember and implement. Reminders were relayed via email to the teams involved in the care of the patients, to initiate ACP discussions.
Results The implementation of ACP in the medical unit, occurred in phases.
From 2013–2014, the number of ACP discussions doubled with promotion of ACP and facilitator training.
From 2015–2016, the numbers increased by 60% after introduction of formal screening for new admissions using our three key triggers.
In 2017, these numbers were maintained even after we stopped formal screening and email reminders.
Conclusion ACP rates increased, using the three-pronged approach of implementation, with improved sustainability and consistency.
Future initiatives may focus on refining the triggers, and incorporating them into medical records systems.
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