Increasing advance care planning referrals for chronic obstructive pulmonary disease patients in the emergency department

In Singapore General Hospital (SGH), patients with chronic obstructive pulmonary disease (COPD) are referred for advance care planning (ACP) at the specialist outpatient clinics with about 50 cases referred a year and a completion rate of 10%. One of the commonly cited reasons by patients is that they are feeling well currently and do not need to talk about ACP at that moment. The Emergency Department (ED) saw about 240 COPD patients of P2 or P3 acuity yearly and might be a strategic place for ACP advocacy to take place for COPD patients who are triaged as P2 or P3 acuity. While the memory of the recent exacerbation remains fresh, it could be an opportune moment to start an ACP conversation with such patients in the ED. A quality improvement project (QIP) led by both ED nurses and doctors was executed to increase the number of ACP referrals for COPD patients from the ED. A total of 16 COPD ACP referrals were made, up from the previous baseline of zero. Of note, two of the 16 referrals (12.5%) completed the ACP process. Four more (25%) are still in midst of ACP completion at time of project conclusion.