Abstract
Background: There are many barriers causing unclear communication pertaining to people’s choices for end-of-life (EOL) care including their existing wishes being unfulfilled, poor communication between patients and providers, and inadequate clinician training. The Portable Orders for Sustaining Life Treatment (POLST) were found in studies to be an effective tool for ensuring patients’ wishes were honored. In addition, a “Surprise Question” approach has been utilized to initiate advance care planning (ACP) conversations.|Purpose: The purpose of this quality improvement project was to design, develop, implement, and evaluate a POLST guideline process at Bridgeport Family Medicine (BFM).|Method: The Iowa model and the “Surprise Question” were used to prompt clinicians to indicate POLST conversation. Outcome measures included a five-point Likert scale for the educational session, current procedural therapy (CPT) 99497 or 99498 codes, and POLST Registry data were collected to evaluate the effectiveness of the project.|Results: The POLST educational sessions showed a statistically significant increase in providers and staff knowledge (M = 16.7, SD = 3.1, 1 month posttest M = 20.4, SD = 1.1, p <.001) and increased use of the POLST process from 11% to 20%.|Conclusion: Since BFM only had a small number of patients that met the criteria for inclusion using the “Surprise Question”, it is recommended that POLST discussions should continue, and changing the criteria for patients who have five or more chronic diseases may be more appropriate. Furthermore, continuing to discuss ACP during the annual Medicare Wellness Exam (MWE) and review/update POLST if applicable is important in order to honor the patient’s current EOL wishes.| Keywords: Portable Orders for Life-Sustaining Treatment (POLST), advance directive (AD), “Surprise Question”, Advance Care Planning (ACP)