PRP155: RIPE for Change: Residency Improvement of POLST Education

Rebecca Howe, MD; Grace Amadi, MD

Abstract

Context: Physician Orders for Life-Sustaining Treatment (POLST) forms communicate a patient’s wishes during medical crises. Despite the usefulness of POLSTs, many providers do not understand how to correctly interpret or complete them with patients. At our institution, only 16% of high-risk patients have a POLST form and there is no POLST curriculum for resident physicians.
Objective: 1. To create and implement a POLST curriculum to increase resident knowledge and accurate completion of POLST forms. 2. To conduct a QI panel management project with residents to identify and target high risk patients for advance care planning (ACP) and POLST completion.
Study Design: 2-part QI project: educational session and panel management
Setting: Academic medical center, family medicine, outpatient.
Population studied: All UC Davis Family Medicine Residents
Intervention: In RIPE Part 1, we designed a POLST curriculum in collaboration with the Coalition for Compassionate Care of California (CCCC) to teach residents to interpret and complete a POLST. In RIPE Part 2, residents learn to run an EMR report on their patient panel to identify high risk patients and those lacking a POLST or advance directive (AD). They then schedule future visits to discuss ACP with these patients and complete documentation.
Outcome measures: RIPE Part 1: Pre- and post-surveys assessing knowledge and pre- and post-curriculum POLST completion accuracy. RIPE Part 2: Percentage of high risk family medicine patients with a completed POLST or AD.
Results: RIPE Part 1 led to an increase in POLST-related knowledge (Pre-Test average 65%; Post-Test average 79%). It also led to an increase in useable POLST forms (Pre-Test usable POLSTs 39%, Post-Test usable POLSTs 56%). RIPE Part 2 showed unchanged POLST or AD completion rates between November and April among all Family Medicine Department patients (7% vs 8%) and among patients at high risk of hospital admission (16% vs 15%).
Conclusions: RIPE Part 1 was effective at increasing resident knowledge and accurate POLST form completion. RIPE Part 2 did not result in an increase in POLST completion rates among high risk patients. Barriers include resident lack of comfort with ACP discussions, patient hesitation to discuss ACP, and inconsistent follow-up to continue discussions. Potential solutions include holding an educational session on early ACP conversations and integrating ACP documentation with the Health Maintenance tab of the EMR.

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