A recent audit of the electronic health records of deceased patients at the University of Florida’s Shands Hospital in Gainesville, Fla., found that 47 percent had filed advance directives with UF Health. That represents huge progress from 2013, when the number was more like 6-8 percent, according to Anthony Clarizio, executive director of UF Health Shands HomeCare and ElderCare of Alachua County.
Two years ago, the chief medical officer and chief quality officer at UF Health asked Clarizio to take a look at improving the number of patients with advance directives on file.
The Joint Commission requires hospitals to inquire about advance directives for all patients, but there is no standard for how many patients have to have living wills on file, but Clarizio has a goal in mind. “94 percent is where we should try to get to,” he said. That was the benchmark set by Gundersen Health System in LaCrosse, Wis., which has made national and international headlines in recent years for its Respecting Choices initiative on end-of-life planning.
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“We’re making positive strides in advance directives without having a whole, dedicated department,” Clarizio said. The IT department at UF Health has created “best-practice alerts” within the Epic Systems EHR to indicate if there is an advance directive within the system but not in front of the treating physician, or if a patient has been given a form but hasn’t completed it.
“If you don’t have one, someone will offer you the opportunity to have a discussion,” Clarizio said. “But we have found that this is not the optimal time to have this discussion.”
UF Health also is struggling with the fact that it has not automated the process. Patients fill out and sign paper forms, then the organization scans these documents into the EHR and adds keywords.
Shands HomeCare also has tried to encourage discussions about advance directives in UF clinics and in the community. Clarizio said his department has reached about 250 people in the community that way in the past year. “I think we’ll do that every year,” and also try to find out why people are hesitant to fill out living wills, he said.
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Still, Clarizio said, “The bigger work is done in the outpatient clinics.”
In the midst of this effort last year, UF Health began circulating a video from Emmi Solutions, a Chicago-based vendor of educational material and communication services for patient engagement. “We cue that out to people at various times,” Clarizio said. This includes patients, employees and patrons at local senior centers.
[youtube http://www.youtube.com/watch?v=DniVlcyVztU]
UF Health held events at three of its facilities on National Healthcare Decisions Day, which fell on April 16 this year.
“It’s ever-evolving and getting better over time,” Clarizio said. He added that it is important to make people feel comfortable about having the discussion about end-of-life care.
Shands now is starting to work on advance directives specifically in African-American communities as part of a new outreach strategy. “We’ve touched the seniors,” Clarizio explained. “Now we’re going to touch ethnic communities.”
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