SHM Converge Scientific Abstract ePoster Gallery-Development and Implementation of a Non-Interruptive Best Practice Alert Using Dual Algorithms to Enhance Advance Care Planning in High-Risk Hospitalized Patients

Development and Implementation of a Non-Interruptive Best Practice Alert Using Dual Algorithms to Enhance Advance Care Planning in High-Risk Hospitalized Patients

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This Stanford Medicine project developed and tested a non-interruptive Best Practice Alert (BPA) in the electronic health record to improve advance care planning (ACP) for high-risk hospitalized patients. The goal was to identify patients most likely to benefit from ACP discussions and prompt clinicians without disrupting workflow.<br /><br />The BPA used a dual-algorithm approach: patients had to rank in the top 25th percentile for predicted 12-month mortality risk and have a greater than 20% chance of 30-day readmission. Eligible patients were randomized 2:1 into BPA-on and BPA-off groups. In the BPA-on group, the alert appeared on the patient summary page and storyboard and linked directly to ACP documentation tools; in the BPA-off group, the alert was hidden.<br /><br />From October 2022 to October 2024, 94,088 total discharges occurred, and 6,142 encounters met BPA criteria. The intervention was active on medicine and oncology services, with 4,026 encounters in the BPA-on group and 2,116 in the BPA-off group. Fisher’s exact test was used to compare groups.<br /><br />The findings showed higher ACP note documentation in the BPA-on group than in the BPA-off group, suggesting that the alert improved ACP engagement while minimizing disruption to clinical workflow. Overall, this innovation demonstrates a scalable and sustainable EHR-based strategy to support goal-concordant care in high-risk hospitalized patients.

Asset Subtitle

Samantha Wang

Meta Tag

Author List Brian Schenone, Briththa Seevaratnam, Lisa Shieh, Samantha Wang, Stephen P. Ma, Winifred Teuteberg

Category Innovations

Concept Advance care planning

Concept Patient Values

Concept Best Practice Alert

Concept Mortality Risk Predictor

Concept ACP Documentation

Distinguished Non-Finalist

Presenter Organization Stanford University

Presenting Author Samantha Wang

Track Technology in Hospital Medicine

Keywords

advance care planning

best practice alert

electronic health record

hospitalized patients

mortality risk

readmission risk

clinical workflow

goal-concordant care

documentation

Stanford Medicine

Advance care planning

Patient Values

Best Practice Alert

Mortality Risk Predictor

ACP Documentation