title: Implementation of a quality improvement programme to support advance care planning in five hospitals across a health region.
abstract: OBJECTIVE
  Advance care planning (ACP) can help patients with a terminal illness to prepare for the end of their lives. This report describes a regional service improvement initiative to increase the identification of hospital inpatients at this stage in their illnesses and to increase the number of such patients who are offered the opportunity to start the process of ACP.
  
  
  METHODS
  Data were collected prospectively over a 7 month period from four acute hospital trusts and a specialist cancer centre in the South-West London region. Each unit identified a specific patient population who were screened for eligibility to engage in the process of ACP. Data concerning the reasons for eligibility, the suitability for discussion and the various reasons why patients did not complete the process, were recorded.
  
  
  RESULTS
  Over a 7 month period 1980 patients were screened and 559 (28.2%) were found to be potentially eligible for an ACP discussion. Of these 227/559 (40.6%) were deemed suitable for a discussion by medical staff. The majority of these patients (195/227; 86%) were offered the opportunity to undergo ACP discussions and 144/195 (73.8%) agreed to begin the process of ACP.
  
  
  CONCLUSIONS
  This report shows that a targeted approach can result in increased uptake in the number of patients who engage in ACP. However, systematic identification of potentially eligible patients requires a significant investment of clinical time and resources.
authors.affiliation: Division of Population Health Sciences and Education, St George's University of London, London, UK Kingston Hospital NHS Trust, Surrey, UK.
authors.forename: G
authors.initials: G
authors.lastname: Schofield
authors.affiliation: Kingston Hospital NHS Trust, Surrey, UK.
authors.forename: L
authors.initials: L
authors.lastname: Kreeger
authors.affiliation: Epsom and St Helier University Hospitals NHS Trust, Surrey, UK.
authors.forename: M
authors.initials: M
authors.lastname: Meyer
authors.affiliation: Croydon Health Services NHS Trust, Croydon University Hospital, Surrey, UK.
authors.forename: D
authors.initials: D
authors.lastname: Swann
authors.affiliation: Epsom and St Helier University Hospitals NHS Trust, Surrey, UK.
authors.forename: A
authors.initials: A
authors.lastname: Wijeratne
authors.affiliation: The Royal Marsden and Royal Brompton Palliative Care Service, The Royal Marsden NHS Foundation Trust, The Royal Marsden, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Wood
authors.affiliation: Division of Population Health Sciences and Education, St George's University of London, London, UK.
authors.forename: P
authors.initials: P
authors.lastname: Stone
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration* / Q000706:statistics & numerical data; D004608:Eligibility Determination; D006284:Health Plan Implementation / Q000458:organization & administration*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D008131:London; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement / Q000458:organization & administration*
keywords: Advance Care Planning; Discharge Planning; Service Evaluation