Improving Goals of Care Documentation in Primary Care: A Quality Improvement Project

Abstract Background: The Veterans Health Administration through the National Center for Ethics in Healthcare developed the Life-Sustaining Treatment Decision Initiative (LSTDI) to be implemented in all Veterans Health Administration sites in 2018. It was designed to improve healthcare goal discussions, align patient goals with treatment plans, and document goals of care conversations.

Local Problem: Goals of care conversations were not routinely conducted in a small northwestern, Pennsylvania Veterans Affairs facility in accordance with the LSTDI. From 2019 to 2022, there were three documented conversations completed by primary care providers.

Methods: A process map was created to visually analyze clinic workflow prior to project implementation and to identify opportunities for improvement. A revised workflow was developed, adding an interdisciplinary team huddle and a clinic appointment incorporating goals of care conversations. Measures included the number of appointments that were scheduled, the number of appointments that were attended by eligible patients, and the number of completed Life Sustaining Treatment (LST) notes.

Interventions: A revised workflow was developed, and education was provided to project participants. The workflow was implemented June 8, 2023, to August 10, 2023, and results were analyzed.

Results: Twenty-one patients were eligible for a goals of care clinic appointment. Ten patients were scheduled for an appointment, and eight patients (80%) had a documented LST note. Four additional patients who were not part of the revised workflow had documented LST notes.

Conclusions: The revised workflow led to an increase in the number of documented goals of care conversations. A major limitation was the lack of available goals of care conversation clinic appointments.

Key words: primary care, goals of care conversations, documentation.  

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Work Title Improving Goals of Care Documentation in Primary Care: A Quality Improvement Project
Access
Open Access
Creators
  1. Heron Warren
Keyword
  1. DNP Project
  2. Primary care
  3. Goals of care conversations
  4. Documentation
License No Copyright - U.S.
Work Type Project
Acknowledgments
  1. Susan Maynard, DNP, MS, RN-BC, CCNS-CMC, CCRN-K
  2. Sheri Matter, PhD, RN, NEA-BC
  3. Kelly Wolgast, DNP, RN, FACHE, FAAN
Publication Date February 20, 2024
Language
  1. English
Geographic Area
  1. Northwestern Pennsylvania
Deposited February 20, 2024

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  • Updated
  • Updated Acknowledgments Show Changes
    Acknowledgments
    • Susan Maynard, Sheri Matter, Kelly Wolgast
  • Added Creator Heron Warren
  • Updated Publication Date Show Changes
    Publication Date
    • 2024-20-02
    • 2024-02-20
  • Added Warren_Heron_Improving Goals of Care Documentation in Primary Care A Quality Improvement Project.docx
  • Updated Acknowledgments, License Show Changes
    Acknowledgments
    • Susan Maynard, Sheri Matter, Kelly Wolgast
    • Susan Maynard, DNP, MS, RN-BC, CCNS-CMC, CCRN-K, Sheri Matter, PhD, RN, NEA-BC , Kelly Wolgast, DNP, RN, FACHE, FAAN
    License
    • https://rightsstatements.org/page/NoC-US/1.0/
  • Published
  • Updated Keyword, Geographic Area Show Changes
    Keyword
    • DNP Project, primary care, goals of care conversations, documentation
    • DNP Project, Primary care, Goals of care conversations, Documentation
    Geographic Area
    • Northwestern, Pennsylvania
    • Northwestern Pennsylvania
  • Updated