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UCD Howe

TITLE: RIPE for Change: Residency Improvement of POLST Education

Rebecca Howe, MD; Nathan Zacharias, MD; Cecilia Jojola, MD; John MacMillan, MD; Quy Tran, MD; Grace Amadi, MD

Introduction: Physician Orders for Life-Sustaining Treatment (POLST) forms communicate a patient’s wishes during medical crises. Despite the usefulness of POLSTs, many providers do not understand how to correctly interpret or complete them with patients. At our institution, only 16% of high-risk patients have a POLST form and there is no POLST curriculum for resident physicians. Our project has two goals: 1. To create and implement a POLST curriculum to increase resident knowledge and accurate completion of POLST forms, and 2. To conduct a QI panel management project with residents to identify and target high risk patients for advance care planning (ACP) and POLST completion.

Methods: In RIPE Part 1, we designed a POLST curriculum in collaboration with the Coalition for Compassionate Care of California (CCCC) to teach residents to interpret and complete a POLST. In RIPE Part 2, residents learn to run an EMR report on their patient panel to identify high risk patients and those lacking a POLST or advance directive (AD). They then schedule future visits to discuss ACP with these patients and complete documentation.

Results: RIPE Part 1 led to an increase in POLST-related knowledge (Pre-Test survey average 65%; Post-Test average 79%). It also led to an increase in useable POLST forms (Pre-Test usable POLSTs 39%, Post-Test usable POLSTs 56%). RIPE Part 2 showed unchanged POLST or AD completion rates between November and March among all Family Medicine Department patients (7% vs 7%) and among patients at high risk of hospital admission (16% vs 15%).

Conclusions: RIPE Part 1 was effective at increasing resident knowledge and accurate POLST form completion. RIPE Part 2 did not result in an increase in POLST completion rates among high risk patients. Barriers include resident lack of comfort with ACP discussions, patient hesitation to discuss ACP, inconsistent follow-up to continue discussions. Potential solutions and next steps include holding an educational session on early ACP conversations and integrating ACP documentation with the Health Maintenance tab of the EMR.  

POSTER CONTACT: Dr. Rebecca Judith Howe; rjhowe@ucdavis.edu