Recognizing Quality Advance Care Planning Documentation: A Quality Improvement Initiative.

BACKGROUND

ACP documentation in oncology emergency care frequently fails to capture patient values, reasoning, and voice, limiting its clinical utility.

MEASURES: A five-domain ACP Documentation Quality Rubric (patient/family voice, goals/values, decision clarity, shared decision-making, plan integration) classified notes as Basic, Adequate, or Exemplary; the primary outcome was the proportion rated Exemplary.

INTERVENTION: Six components launched February 2026: provider education, exemplar dissemination, reviewer calibration, a point-of-care poster, unit champions, and formal kudos recognition of exemplary documentation.

OUTCOMES: Exemplary documentation rose from 14.98% (49/327) at baseline to 21.54% (129/599) post-intervention, a 43.7% relative increase exceeding the 15% target (p=0.016); inter-rater reliability improved (weighted kappa 0.41 to 0.53).

CONCLUSIONS/LESSONS LEARNED: Standardized rubrics paired with peer recognition can measurably improve ACP documentation quality in a high-acuity oncology setting; sustainability and downstream patient outcomes warrant further study.