SHM Converge Scientific Abstract ePoster Gallery-Pertinent in Pink: A Qi Initiative to Increase Polst Documentation

Pdf Summary

This quality improvement project aimed to increase documentation of life-sustaining treatment preferences by improving completion of POLST forms among hospitalized adults with DNR status at discharge on a general medicine service at Oregon Health & Science University.<br /><br />Before the intervention, only 35% of hospitalized adults with a DNR order at discharge had a completed, concordant POLST form, suggesting a gap in end-of-life preference documentation and a risk of unwanted resuscitation or intensive care. The team used the electronic health record and Oregon POLST Registry data to identify eligible patients and track monthly POLST completion rates over time.<br /><br />From July 2019 through December 2022, there were 388 admissions representing opportunities for appropriate POLST completion. Three interventions were tested:<br />1. An educational session for internal medicine hospitalists on ePOLST use.<br />2. An electronic discharge navigator alert.<br />3. Quarterly individualized, blinded peer-comparison feedback emailed to discharging providers.<br /><br />The first two interventions had little short-term impact. However, after the third intervention, POLST completion rates improved significantly, rising from 35% in the pre-intervention period to 60% during the final intervention period. A binomial proportions test confirmed this was a statistically significant shift (p = 0.001).<br /><br />The study concluded that baseline POLST completion rates were unacceptably low, and that general education plus EHR alerts were not enough to change behavior meaningfully. In contrast, personalized performance feedback comparing providers to peers led to a substantial and sustained improvement in POLST completion.

Asset Subtitle

David C. Harmon

Meta Tag

Author List Bryanna DeLima, David C. Harmon, Katie Drago, Kellie Littlefield, Mary Brooks

Category Innovations

Concept POLST

Concept DNR Status

Concept Quality Improvement

Concept POLST Completion Rate

Concept Life-Sustaining Treatment

Distinguished Non-Finalist

Presenter Organization Oregon Health and Science University

Presenting Author David C. Harmon

Track Quality Improvement

Keywords

POLST

life-sustaining treatment

DNR

end-of-life documentation

hospitalized adults

general medicine

electronic health record

peer comparison feedback

quality improvement

Oregon Health & Science University

POLST

DNR Status

Quality Improvement

POLST Completion Rate

Life-Sustaining Treatment