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What Does Austin Health Do?

The Effectiveness of Employing Exclusive Advance Care Planning (ACP) Clinicians Kasey Wallis, Karen Detering , Kathy Whiteside, Daveena Mawren , Rebekah Sjanta , Dorothy Campbell, William Silvester. What Does Austin Health Do?. 97,501 inpatient admissions. > 900 beds. 170,497 outpatients.

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What Does Austin Health Do?

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

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

  3. A Large Health Care Provider Primary catchment area 118km2 Extended catchment area 1800km2 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 Supported by hospital policy ACP outcome Hi I’m Kathy Not completed Patients referred to RPC Conversation no ACD doc Completed≥1 ACD doc Consultation with ACP Clinician Patient identified by ACP Clinician Via EHR SDM (MEPOA) RTC SOC

  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

  9. 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).

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

  11. Proportion of Clinician Facilitated ACDs

  12. Resuscitation Preferences by Primary Diagnosis

  13. Life Prolonging Treatment Preferences by Primary Diagnosis

  14. 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

  15. Are we targeting the right patients?

  16. 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

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

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