Impact of a Comprehensive End-of-Life Admission Order Set on Clinician Self-Rated Care Proficiency.

Abstract

Context: High-quality end-of-life (EOL) care is essential to ensure comfort, dignity, and goal-concordant care. Despite its importance, variability in practice and clinician-reported challenges with preparedness and guidance persist. Electronic health record-based order sets may standardize EOL care, but their impact across settings is not well defined.

Objectives: Assess the impact of a comprehensive order-set on provider proficiency with EOL care.

Methods: Clinician perceptions of satisfaction with EOL guidance, preparedness for care delivery, and ease of order process were assessed pre- and postimplementation of an electronic EOL admission order set at St. Jude Children's Research Hospital. Comparison between baseline (T1) and postimplementation (T2) responses used Chi-squared or Fisher's exact tests and ordinal logistic regression. McNemar's test, Stuart-Maxwell test, and mixed‑effects ordinal logistic regression were utilized for retrospective response analysis.

Results: A total of 340 survey responses were analyzed (T1: n = 197; T2: n = 143). Implementation was associated with significant improvements in satisfaction with EOL guidance among prescribers (including physicians and advanced practice providers) (very satisfied: 10.9% → 33.9%, P = 0.004) and nurses (7.1% → 19.7%, P = 0.028). Nurses reported substantial increases in preparedness (very prepared: 14.2% → 53.0%, P < 0.001). Prescribers reported greater ease in placing and following EOL orders (odds ratio [OR] = 2.81; 95% confidence interval [CI]: 1.82-4.37; P < 0.001). Retrospective assessment at T2 demonstrated higher satisfaction after implementation than before (OR = 2.39; 95% CI: 1.44-3.97; P = 0.001). Improvements were consistent across roles and experience levels.

Conclusion: Implementation of a standardized EOL admission order set can improve clinician reported satisfaction, perceived preparedness, and workflow efficiency in EOL care processes, which may result in enhanced EOL care delivery.