Implementation of an Advance Directives Completion Protocol for Hospitalized Patients With Serious Illness: A Quality Improvement Initiative.

Despite mandates requiring hospitals to offer advance directives to all patients, many adults do not have advance directives in place at the end of life. This quality improvement project aimed to implement an evidence-based, standardized protocol to increase advance directive completion rates for hospitalized patients with serious illnesses. A preimplementation and postimplementation design was used to evaluate the impact of an educational intervention and advance directive completion protocol. The project was conducted at a midsized urban community hospital in the Northeastern United States. Charts were reviewed for 250 patients with serious, chronic illnesses admitted under family medicine. Over the 11-month project period, advance directive completion rates increased from 21% (17/82) preintervention to 43% (73/168) postintervention, a statistically significant improvement of 22% ( P = .001). Protocol compliance rates increased from 0% to 50% (8/16) for nurses and from 17% to 31% (9/52 to 21/68) for resident providers. The results support the use of a standardized advance directive completion protocol, combined with educational sessions, to improve advance directive completion rates for seriously ill patients and safeguard their autonomy at the end of life.