Project Information

Increasing Advance Directives documentation utilizing inpatient, ambulatory, and community-based efforts

Project Description: Advance Directives (AD) are medically-oriented written documents that include healthcare surrogate designation and plans for treatment when patients are unable to speak for themselves. Studies show most people have surrogates and plans in mind, but few communicate these goals to family and clinicians. Without an AD, a medical intervention may not match the goals of care. Clinicians are only able to follow ADs when they are documented in the Electronic Health Record (EHR) if a patient cannot speak for herself or they must identify the patients’ next of kin. ADs provide a plan for scenarios in which a patient cannot make their own decision. They allow a patient to determine a proxy decision-maker, with the goal of taking the stress off of the patient, family, and clinical team. This proves problematic if selected designees and plans for care are not communicated effectively beforehand. To address the gap of limited AD in the EHR our project utilized a multi-pronged approach to 1) improve clinician, patient, and family education in the inpatient and ambulatory settings and 2) conduct community-based efforts to normalize AD completion and its rate of documentation in the EHR. Standard rapid-cycling quality improvement methodology and related evidence-based research were used to develop the educational brochure in the inpatient and ambulatory settings, processes for the SCT in the clinics, and implementation of the Death over Dinner and Before I Die walls in the community.

QPI: Saikrishnapriya, Gunasegaran, (

Collaborators: Ciera, Hall, (; Harrison, Brandes, (; Abigail, Wolz, (

Advisors: Jacqueline, Baron-Lee, (

UF Health Big Aims: Zero Harm None

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