Introducing and Implementing a Universally Accepted,Readily Accessible,and Actionable End-of-Life Planning Tool for Patients with Advanced Serious Illness or Frailty in Southern New Zealand

Abstract

Background:

Each health provider/agency in Southland, New Zealand, previously had its own forms and processes to document and communicate the planned scope of treatment; this project attempted to consolidate and streamline these variable processes into one actionable medical order that is valid in all settings.

Aim:

The hypothesis was that the intervention would reduce unnecessary hospitalizations in the final year of life.

Design:

The Clinical Order Articulating Scope of Treatment (COAST) form was a single-page medical order designed to document and communicate the resuscitation status and scope of medical treatment for adult patients believed to be in the final year of life, as evidenced by a “no” response to the Surprise Question. This three-phase initiative piloted the use of the COAST form in Southland from May 2019 to January 2020.

Results:

One hundred eighty-three patients with COAST forms consented to study participation. Sixty-one percent had a malignant primary diagnosis. The average number of emergency department (ED) presentations in the 12 months before COAST form implementation was 1.5 per person, and the average number of hospital admissions per person was 2.2. This was reduced to 0.5 and 0.5, respectively, in the 12 months following COAST implementation (p = 0.00). Three patients had no ED presentations/hospital admissions in the 12 months before COAST implementation, compared with 29 following COAST implementation, and 66.7% of patients died between May 2019 and February 2021.

Conclusions:

Patients with a COAST form had significantly fewer ED presentations and hospital admissions in the 12 months following implementation.