Background:
Hospitalisation rates for older people are increasing, with end-of-life care becoming more medicalised. Innovative approaches to identify likely end-of-life, communicate prognosis, provide care consistent with people’s preferences, and save healthcare resources are needed.
The Intervention for Appropriate Care and Treatment (InterACT) trial was an NHMRC-funded project partnering with three large tertiary hospitals in South-East Queensland. The aim was to improve appropriate care and treatment decisions for older people at the end of life, through clinical audit and implementation of a prospective feedback loop notifying clinicians of any patients under their care determined as at-risk.
Change:
The InterACT trial used automated processes to communicate patient at-risk status to senior clinicians, taking advantage of the digitalisation of medical records. A dual notification feedback system was used: system one was an alert tailored to the patient record systems used in each hospital; these included adding the alert to the patient’s medical record, to the electronic medical handover template and placing a visual flag on the patient’s name displayed on the journey board in their admitted ward. System two was consistent across all sites, an email sent at the end of each screening day to the clinician of any patient deemed at-risk.
The intent was to alert clinicians to patients at risk of receiving non-beneficial treatment at end of life, prompting conversations with patients and their families about care options and patient choices, leading to review and completion of the patient’s advance care planning documents.
Learnings:
In co-designing the trial intervention with clinical teams, consideration was required to ensure that the audit feedback did not undermine clinician autonomy, was not prescriptive, and did not interfere with routine clinical practice. The intervention failed to change the completion of advanced care documents. Limited visibility of the initial notification and the timing of the second notification, late in the day, likely contributed to limited behaviour change. Our notification was also passive which could be overlooked or ignored. Privacy constraints restricted the ability to provide detailed patient information and electronic systems were not always utilised by clinical teams. Finding effective ways to tailor notifications to meet clinician needs in an acute care setting requires further investigation