Advance Care Planning for Emergency Department Patients with COVID-19 Infection: An Assessment of a Physician Training Program (QI411)

OUTCOMES: 1. Describe the components of an educational toolkit to improve advance care planning in the emergency department for patients with COVID-19 2. Appraise the effectiveness of an educational toolkit to improve advance care planning in the emergency department for patients with COVID-19 BACKGROUND: The sudden emergence of coronavirus disease 2019 (COVID-19) heightened the importance of advance care planning (ACP) conversations, particularly in the emergency department (ED). The objective of this quality improvement project was to determine the effect of an educational training program (“toolkit”) for emergency providers on ACP conversations in the ED during the COVID-19 pandemic. AIM STATEMENT: We sought to examine the efficacy of an emergency provider–facing educational intervention, led by palliative care physicians, on the initiation of ED-based ACP for patients with COVID-19. METHODS: This was an evaluation of a quality improvement project at an academic ED using observational pre-/post-interventional data. Palliative care physicians delivered a 60-minute ACP educational intervention for emergency medicine providers in conjunction with release of reference documents as part of an educational toolkit. Initial training occurred on April 1, 2020. Measured outcomes for each patient included identification of a healthcare decision maker (HCDM), an order for a code status, or a documented goals-of-care (GOC) conversation. RESULTS: In total, 143 charts of patients with confirmed COVID-19 presenting for ED care between March 26 and May 25, 2020 were reviewed. There was exceptional representation in gender, race, and ethnicity, with 58% of participants being female, 29% Black, and 49% Hispanic/Latino. There was a 25.4% (95% CI, 7.0-43.9) increase in ED-based ACP, as measured by documentation of at least an HCDM, code status, or GOC conversation. Even after adjustment for patient demographics, a trend toward increased ACP activity was observed (OR = 2.71, 95% CI, 0.93-8.64). CONCLUSIONS AND IMPLICATIONS: In response to a pandemic threat, we found that a rapid and simple provider-facing educational toolkit was associated with increased ED-based ACP activities for patients with COVID-19.