SHM Converge Scientific Abstract ePoster Gallery-Does Answering the Mandatory Surprise Question Improve the Acp Documentation?

Pdf Summary

This quasi-experimental quality improvement study examined whether using the electronic health record’s “Mandatory Surprise Question” (MSQ) would improve advance care planning (ACP) documentation among patients admitted to a Family Medicine resident-led inpatient service.<br /><br />The project addressed a common gap in care: ACP conversations about goals of care and code status were often not completed during hospitalization, which could lead to care that did not match patient wishes. The team aimed to increase ACP documentation by at least 20%.<br /><br />The intervention was simple and educational. Residents attended a 15-minute didactics session on the importance of ACP, were introduced to the MSQ, and were encouraged to normalize its use as part of routine care. The team also sent a follow-up email explaining how to use the MSQ in Epic and placed reminder posters in the residents’ lounge.<br /><br />Outcomes were measured by comparing two-week periods before and after the intervention. Before the intervention, only 3% of patients on service had code status discussion and ACP documentation during the hospital encounter. After the intervention, 18% were asked about code status and 15% had ACP documentation.<br /><br />Although the intervention did not reach the exact 20% goal, it showed a substantial improvement in documentation rates. Residents reported barriers including limited confidence in having sensitive conversations and time constraints due to competing clinical duties. Future plans include small-group training to improve residents’ confidence and motivational strategies to help prioritize ACP discussions.<br /><br />Overall, the study suggests that introducing and normalizing the MSQ can meaningfully improve ACP documentation and help integrate these conversations into routine inpatient care.

Asset Subtitle

Omar Fahmy

Meta Tag

Author List Gyanendra Sharma, Hemanth Kilaru, Omar Fahmy, Sadichchha Parajuli

Category Research

Concept Advance care planning

Concept Patient Goals

Concept Code Status

Concept ACP Documentation Rate

Concept Hospitalized Patient

Distinguished Non-Finalist

Presenter Organization Sound Physicians - MultiCare Good Samaritan Hospital

Presenting Author Omar Fahmy

Track Quality Improvement

Keywords

advance care planning

electronic health record

mandatory surprise question

code status discussion

quality improvement

family medicine residency

inpatient care

documentation rates

goals of care

resident education

Advance care planning

Patient Goals

Code Status

ACP Documentation Rate

Hospitalized Patient