Poster Presentation Australian and New Zealand Society for Geriatric Medicine Annual Scientific Meeting 2025

Enhancing Advance Care Planning in Geriatric Medical Wards (GRACP) (119602)

Kim San Lim 1 , Sigaya Kenneth Villan 1 , Espeleta Wrenzie Del Valle 1 , Arroyo Shiela Panao 1 , Rei Tan 1 , Surendra Varman 1 , Kiat Sern Goh 1 , Si Ching Lim 1 , Christopher Tsung Chien Lien 1 , Chun How Ooi 1 , Lip Hoe Koh 1 , Hwee Jin Goh 1 , Hasnah Bt Abdullah 1
  1. Changi General Hospital, Singapore, SINGAPORE

Background

Advance Care Planning (ACP) facilitates patient-centered care by aligning medical treatment with individual preferences. Despite its benefits, ACP referral rates among elderly patients in our acute geriatric wards were low (3–3.9% per month).

Aims

This project aimed to increase ACP referral rates from 3% to 10% over three months in two acute geriatric wards.

Methods

Using Quality Improvement (QI) methodology, we conducted a root cause analysis revealing the barriers such as: time constraints, documentation burden, lack of healthcare provider experience, and limited public awareness.

We implemented targeted interventions:

  • System Optimization: Templates in electronic health records to streamline documentation.
  • Education & Awareness: Online ACP resources shared in physician chat groups, posters and brochures for doctors, patients, and families, and an ACP workbook for patients.
  • Process Integration: Mandating ACP discussion reviews in mortality rounds.

Key data points collected included weekly ACP referrals, duration from admission to referral, hospital length of stay, and 30-day readmission rates.

Results

Following implementation, ACP referral rates increased from 4.3% to 5.27%, with an average of 12.3 days from admission to referral. No significant change was observed in hospital length of stay or 30-day readmission rates.

Conclusion

While a modest improvement was observed, ACP referral rates remain below target. To enhance uptake, we propose default ACP referrals for all acute geriatric admissions, excluding severely ill patients. We aim to conduct qualitative assessments through interviews and focus groups to explore healthcare staff, patient, and family perspectives on ACP, assessing their knowledge, attitudes, and barriers to ACP referrals.

  1. Brinkman-Stoppelenburg, A., Rietjens, J. A. C., & van der Heide, A. (2014). "The effects of advance care planning on end-of-life care: A systematic review." Palliative Medicine, 28(8), 1000–1025.
  2. Chan, K. Y., Chiu, H. Y., Yap, D. Y. H., et al. (2021). "Impact of structured advance care planning program on patients’ wish items and healthcare utilization." Annals of Palliative Medicine, 10(2), 1421–1430.
  3. Agency for Integrated Care. (n.d.). Advance Care Planning (ACP). Retrieved from https://www.aic.sg/care-services/advance-care-planning
  4. Agency for Integrated Care. (n.d.). ACP Workbook (English Version). Retrieved from https://www.aic.sg/wp-content/uploads/2023/06/ACP-Workbook-EN.pdf