1. The Effectiveness of Employing Exclusive Advance Care Planning (ACP) Clinicians The Effectiveness of Employing Exclusive Advance Care Planning (ACP) Clinicians Kasey Wallis, Karen Detering, Kathy Whiteside, Daveena Mawren, Rebekah Sjanta, Dorothy Campbell, William Silvester

2. What Does Austin Health Do? 97,501 inpatient admissions 170,497 outpatients 69,923 emergency presentations Networked across 3 sites >400 acute beds $686M budget > 900 beds =Lots of ACP activity

3. A Large Health Care Provider Primary catchment area 118km 2 Extended catchment area 1800km 2 Under Here

4. A Timely Review of the RPC Service Austin Health has a well established Respecting Patient Choices program since 2002 Period of service development 2007-2012 Equivalent of 2 full-time clinicians (1.6 acute / 0.4 sub-acute) Prospective audit of all patients referred to RPC program during 2010-2011 –Evaluate service effectiveness & inform service development Utilised RPC database & electronic hospital systems –Referral characteristics –Demographics of patients seen –ACP clinician activity & –frequency of Advance Care Directives (ACD)

5. An Overview of ‘Our’ ACP Process Hi I’m Kathy Supported by hospital policy Patients referred to RPC Consultation with ACP Clinician ACP outcome Conversation no ACD doc Completed≥1 ACD doc Not completed RTCSOC SDM (MEPOA) Patient identified by ACP Clinician Via EHR

6. The statistics: 2010-2011 Service Delivery 1580 referred 1463 (93%) had ACP 79% acute hospital 20% sub-acute hospital 1% other 454 (31%) died

7. Are Patients Referred to ACP Clinicians Representative of Austin Inpatients?

8. Referred Patients: Primary Admission Diagnosis

10. Relationship Between Visits and ACD Completion Mean time for consultation 3 days (SD 11, range 0-236) Median (range) ACP visits: 2 (1-11) ACP clinician vists/discussions significant association with ACD completion (p<0.001).

11. ACP Activity: Total time vs. ACD Completion Chi square = 129.752, p<0.001 Chi square = 129.752, p<0.001

12. Proportion of Clinician Facilitated ACDs

13. Resuscitation Preferences by Primary Diagnosis Resuscitation Preferences by Primary Diagnosis

14. Life Prolonging Treatment Preferences by Primary Diagnosis

15. SOC: Undesired Medical Treatment Indicated Clinician facilitated SOC n=370 Quality audit of 98 (26%) of these SOC’s 71 (72%) indicated undesired medical treatment

16. Are we targeting the right patients?

17. What makes Austin’s Service Model Effective? Dedicated and supported ACP clinicians ACP clinicians devoted to particular specialty areas Patient-centred approach Multi-staged approach across the continuum of care Processes and policy for recording/alerting clinicians to ACDs & executive support Systematic education of medical, nursing & allied health staff

18. Many thanks for your time today and to the Austin Health RPC Team