Discussing serious illness with patients is a vital competency for healthcare professionals. A review of mortality records at an urban academic medical center revealed gaps in initiating timely serious illness conversations (SICs) and advance care planning (ACP), both essential to ensuring treatments align with patient-centered goals. This study sought to increase the detection and documentation of SICs among patients identified as having low one-year survival likelihood based on updated Charlson Comorbidity Index (CCI) scores.This quality improvement (QI) project gathered data before and after the intervention at a major urban Level I trauma center in Virginia that functions as a key teaching facility for roughly 400 residents and fellows. Researchers performed chart audits to evaluate medical records and hospital stay information. Statistical analysis employed chi-square tests, with significance defined as P < 0.05. Integrated care managers received training to flag elevated CCI scores and address them during multidisciplinary rounds. Clinicians were prompted to record SICs in extent of care (EOC) notes using the institution’s cloud-based electronic health record system (EHR), EPIC. A total of 62 patients with elevated CCI scores were included, of whom 16 (25.81%, P = 0.0001) had documented EOC notes. Individuals with EOC documentation showed markedly higher rates of care focus changes, leading to increased palliative care consultations (63.04% vs. 50%, P = 0.007) and hospice referrals (93.48% vs. 68.75%, P = 0.01) compared to those lacking such notes. Follow-up provider surveys indicated that although half conducted SICs, fewer used EOC notes to document them. Findings from this preliminary effort indicate that proper documentation of SICs promotes greater involvement in ACP, palliative care services, hospice referrals, and do-not-resuscitate orders.
