Background: Ideally, all patients should have a designated medical durable power of attorney (MDPOA) in the event that they are incapable of making decisions for themselves when admitted to the hospital. This best practice ensures that patient wishes are being followed and eliminates the burden of identifying a medical proxy during a critical and stressful time period. Our hospital medicine division created a new transitions of care coordinator role to help close this care gap that was identified in our oncology inpatient population.
Purpose: To increase the MDPOA completion rate to over 90% for patients discharged from oncology hospitalist service lines between December 19, 2022 to June 30, 2023.
Description: The Division of Hospital Medicine created a new clinical support role called the transitions of care coordinator, and one of the responsibilities of the coordinator included auditing MDPOA documentation rates within the electronic health record and assisting patients admitted to the oncology hospitalist service line with MDPOA completion. Since this position was new and the coordinator was non-clinical, the coordinator completed training facilitated by the clinical directors and social workers. Key elements of the training included the following: 1. The use of normalizing language about selecting an MDPOA a. “We noticed that you do not have an MDPOA on file.”b. “We recommend that all people have one in case of an emergency situation.” c. “If you ever get so sick that you cannot make medical decisions for yourself, who would you choose to make decisions for you on your behalf?” 2. Review of MDPOA requirements and state law3. Review of the standardized MDPOA hospital form On daily basis, the care coordinator would complete a chart audit of the inpatient oncology service line and identify inpatients without documented MDPOAs. The care coordinator would then contact the primary team to ensure that the patient had decision making capacity to delegate an MDPOA and if so, the care coordinator would approach the patient and review the form with the patient. If the patient decides to complete the form, a copy is scanned into the electronic health record and the original is returned to the patient. To track this process, an MDPOA data dashboard was created.Between July 1, 2021 and June 30, 2022, the medical oncology service line discharged 1623 patients and 66.2% of patients had a listed MDPOA. The pilot began on December 19, 2022 and from then until June 30, 2023, the MDPOA completion rate increased to 91.8%. During this time interval, 1055 patients were discharged from the service line, and the care coordinator assisted 219 patients (21% discharged patients) with completing their MDPOA assignments.
Conclusions: Advanced care planning is the cornerstone of comprehensive oncologic care. As a service line, we made an intentional hiring decision with a dedicated role to assist our patients with completing MDPOA documentation. With appropriate training and guidance, our coordinator has gained the expertise to normalize and standardize a critical piece of advanced care planning.