• Cruz CarrerasMaría TMTDepartment of Emergency Medicine (M.T.C.C., N.N., E.T., K.T., F.Z., N.R., M.G., S.A.H.), Department of Critical Care Medicine, Department of Integrated Ethics in Cancer Care, The University of Texas MD Anderson Cancer Center, Houston, Nico Nortjé, Emily Thompson, Karen Terrell, Fan Zhang, Nisha Rathi, Marina George, and Sajid A Haque.
• Department of Emergency Medicine (M.T.C.C., N.N., E.T., K.T., F.Z., N.R., M.G., S.A.H.), Department of Critical Care Medicine, Department of Integrated Ethics in Cancer Care, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA. Electronic address: mcruz3@mdanderson.org.
• J Pain Symptom Manage. 2024 Sep 1; 68 (3): e161e166e161-e166.

ContextAs patients approach the end of life, discussion of their treatment goals is essential to avoid unnecessary suffering and deliver care in a manner consistent with their overall values.ObjectivesImplement a multipronged approach to improve the rates of advance care planning (ACP) documentation among providers admitting patients with cancer to the intensive care unit (ICU) from the emergency department (ED).MethodsWe developed multiple interventions including the development of a best-practice advisory to alert providers when patients had previous do-not-resuscitate orders; standardization of ACP documentation; early oncologist involvement in goals-of-care conversations with patients; a survey of ED providers to identify barriers to success; and positive reinforcement strategies aimed at improving the rates of ACP documentation in patients admitted from the ED to the ICU.ResultsPrior to our interventions, only 13% of patients admitted to the ICU from the ED had ACP notes. This percentage increased to 90% by the last month of our project.ConclusionThrough our multipronged approach, we significantly improved the rates of ACP documentation among providers admitting patients from the ED to the ICU.Published by Elsevier Inc.

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