Increasing Medical Power of Attorney Completion for Hospitalized Patients During the COVID Pandemic: A Social Work Led Quality Improvement Intervention

The high risk of mechanical ventilation with COVID hospitalizations requires health-care systems to rapidly innovate advance care planning (ACP) delivery for hospitalized patients to promote goal-concordant care. Assess the impact of a social work and care management intervention on the proportion o...

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Bibliographic Details
Published in:Journal of pain and symptom management 2021-03, Vol.61 (3), p.579-584.e1
Main Authors: Singh, Sarguni, Herrmann, Katie, Cyriacks, Wendy, Youngwerth, Jeanie, Bickel, Kathleen E., Lum, Hillary D.
Format: Article
Language:English
Subjects:
Advance care planning
Advance Care Planning - organization & administration
Advance Directives
Attorneys
Brief Quality Improvement Report
Care plans
Clinical outcomes
COVID-19
Durable power of attorney
Electronic Health Records
Health care management
Health services
health systems
High risk
hospital medicine
Hospitalization
Hospitalized
Humans
Interdisciplinary aspects
Intervention
Living Wills
Management
Mechanical ventilation
Medicine
Needs assessment
palliative care
Pandemics
Patient Care Planning
Patients
Quality control
Quality Improvement
Quality management
Social Work
Social workers
Ventilation
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Summary:The high risk of mechanical ventilation with COVID hospitalizations requires health-care systems to rapidly innovate advance care planning (ACP) delivery for hospitalized patients to promote goal-concordant care. Assess the impact of a social work and care management intervention on the proportion of admitted patients each week with a Medical Durable Power of Attorney (MDPOA). Social workers were consulted to assist with identification of a surrogate decision maker and completion of MDPOA forms for hospitalized patients. This intervention utilized change management strategies and was implemented between April and June 2020. From a baseline average of 30.1%, the weekly percentage of admitted patients with MDPOA forms rose to 42.8% with correlating evidence of nonrandom special cause variation. Use of change management strategies resulted in rapid implementation of an effective ACP initiative. Ongoing needs include focusing on intervention sustainability and education of interprofessional providers about ACP processes.
ISSN:0885-3924
1873-6513
DOI:10.1016/j.jpainsymman.2020.10.033