Proactive Opportunities for Advance Care Planning (PRO-ACP): improving advance care planning completion among hospitalised internal medicine patients with life-limiting illness.

BACKGROUND

Advance care planning (ACP) completion rates remain suboptimal in acute care settings, particularly among patients with life-limiting illnesses (LLIs). This quality improvement initiative aimed to increase ACP completion rates among internal medicine (IM) inpatients with LLI through systematic patient identification and multidisciplinary advocacy.

METHODS

The Proactive Opportunities for ACP project was implemented across eight IM wards from April to October 2025, using three Plan–Do–Study–Act cycles. Patients with LLI were systematically identified using International Classification of Diseases 10th Revision diagnosis codes from electronic medical records. The intervention involved engagement of senior and junior doctors, ward nurses and ACP coordinators, weekly reminders through a secure digital communications platform and integration of ACP advocacy into routine multidisciplinary team meetings. Primary outcomes measured were weekly ACP completion rates among LLI patients, with conversion rates as secondary outcomes.

RESULTS

Over the 6-month implementation period, ACP completion rates increased significantly compared with FY2024 baseline data. Among LLI patients, completed ACPs increased by 285% from 0.7 per week to 2.0 per week, with the overall conversion rates rising from 24.7% to 36.0%. Similar improvements were observed across all IM patients, with completed ACPs increasing by 440% from 1.4 per week to 6.2 per week and the overall conversion rates improving from 27.5% to 33.4%. The intervention demonstrated positive spillover effects, with increased ACP uptake among non-LLI patients, suggesting broader cultural shifts in clinical practice.

CONCLUSIONS

Systematic patient identification combined with integrated multidisciplinary advocacy significantly enhanced ACP uptake among hospitalised patients. The project’s success extended beyond the target population, indicating that structured quality improvement initiatives can drive broader organisational change. However, sustainability challenges related to manual processes and resource requirements necessitate consideration of automated systems and embedded educational programmes for long-term implementation.