SHM Converge Scientific Abstract ePoster Gallery-Implementing the Mandatory Surprise Question for Improved Advance Care Planning

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This project evaluated the “Mandatory Surprise Question” (MSQ) as a triage tool to identify hospitalized patients nearing end of life and to increase advance care planning (ACP), palliative care (PC), and hospice referrals.<br /><br />The MSQ—“Would you be surprised if this patient died within the next six months?”—was embedded into hospitalist admission order sets in 2020. Patients receiving a “No” response were flagged for ACP support. In 2021, two dedicated ACP social workers began assisting these patients with serious illness conversations and structured ACP documentation. The program expanded to all adult inpatient services in 2022, supported by CME, departmental goals, and feedback on outcomes.<br /><br />Results showed that MSQ-positive patients were much more likely to die during the index admission and at later follow-up intervals, confirming the tool’s usefulness for identifying high-risk patients. ACP note completion among MSQ patients rose sharply from 7.2% in 2020 to 63.7% in 2022. During the same period, palliative care referrals increased from 199 to 622, hospice referrals from 125 to 505, and conversions to inpatient hospice grew from 115 in FY20 to 391 in FY23. The organization’s inpatient Vizient mortality observed-to-expected index also improved, falling from 0.85 to 0.51, placing the institution among the top performers nationally.<br /><br />Overall, embedding the MSQ into routine order sets was well accepted and effective for identifying patients who could benefit from ACP, palliative care, and hospice, while also reducing inpatient mortality and potentially unnecessary interventions. The team is now expanding this approach to ambulatory care.

Asset Subtitle

Gregory Maynard

Meta Tag

Author List Connor Reilly, Eddie Eabisa, Gregory Maynard, Jeffrey Berg, Nathan Fairman, Simon Ascher

Category Research

Concept Mandatory Surprise Question

Concept Advance care planning

Concept Triage Tool

Concept End of Life

Concept Palliative Care

Distinguished Non-Finalist

Presenter Organization UC Davis Health

Presenting Author Gregory Maynard

Track Quality Improvement

Keywords

Mandatory Surprise Question

advance care planning

palliative care

hospice referrals

hospitalized patients

end-of-life care

triage tool

serious illness conversations

inpatient mortality

order sets

Mandatory Surprise Question

Advance care planning

Triage Tool

End of Life

Palliative Care