Dr Rebecca Teng Jing Yap1, Dr Shuen Han Lim1, Dr Nehal Chavan1, Dr Sarah So1,2
1Department of Renal Medicine, Nepean Hospital, Kingswood, Australia, 2The University of Sydney, Sydney, Australia
Biography:
Dr Rebecca Teng Jing Yap completed her medical school at the University of Sydney and is currently a Basic Physician Trainee at Nepean Hospital. Passionate about advancing research and improving patient care, she is committed to contributing through evidence-based practices and continuous professional development.
Aim:
To describe how often ACPs are implemented in admissions under Renal Medicine and determine whether ACPs have increased after implementation on electronic medical records (EMR).
Background:
Chronic kidney disease is associated with a high risk of hospitalisation and clinical deterioration. Despite this, advance care plans (ACP) are not widely implemented. EMR represents an opportunity to record ACPs in a location convenient for staff access.
Methods:
This single-centre retrospective study extracted data from all patients admitted under Renal Medicine at Nepean Hospital for the 6 months preceding and 6 months following implementation of ACPs on EMR (1 February 2022). The primary outcome was a completed ACP. Multivariable analyses were performed for all patients, and a sub-analysis consisting only of patients who died.
Results:
480 discrete patients were admitted in the study period. 261 (54.4%) were male. 222 (46.3%) were admitted before and 258 (53.8%) after EMR ACP implementation. 41 (8.5%) patients had a completed ACP. 59 (12.3%) patients died during their hospital admissions. For all patients, factors associated with completed ACP included increasing age at admission (p<0.001, HR 1.06 (95% CI 1.03–1.10), previous review by Kidney Supportive Care (p=0.001, HR 3.78 (95% CI 1.66–8.59) and death during the admission (p<0.001, HR 5.53 (95% CI 2.61–11.7). Out of the patients who died, 20 (34%) had an ACP completed. For these patients, there were no significant factors associated with completed ACPs.
Conclusions:
EMR was not significantly associated with completed ACPs. However, this study was performed with data from the initial 6 months of EMR ACP implementation and the utility of EMR to record ACPs may improve over time with increasing familiarity from healthcare professionals.