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Improving hospital-based communication and decision-making about scope of treatment using a standard documentation tool
  1. Samuel Abuaf Kohen1,
  2. Rajesh Nair2
  1. 1 Internal Medicine and Critical Care, Comox Valley Hospital, Courtenay, British Columbia, Canada
  2. 2 Institute on Aging & Lifelong Health, University of Victoria, Victoria, British Columbia, Canada
  1. Correspondence to Dr Samuel Abuaf Kohen; samuel.kohen{at}


Background The Vancouver Island Health Authority (VIHA) implemented a standard advance care planning (ACP) document called the medical order for scope of treatment (MOST) in February 2016 to improve end of life communication and documentation. This study aims to see if the MOST implementation improves inpatient ACP documentation when compared with the ‘do not resuscitate’ (DNR) order. Improvement is measured by: (1) proportion of inpatients with documented orders for life-sustaining treatment, (2) discordance between patient’s expressed wishes and chart documentation, (3) patient satisfaction and (4) days admitted to an acute care hospital within 90 days of study inclusion.

Methods We performed a single-centre quality improvement study tracking the effects of MOST implementation. 329 consecutive patients were enrolled at a 215-bed community hospital located in Comox, British Columbia, Canada.

Results The MOST integrated well into the process of care, significantly improving ACP documentation from 33% preimplementation to 100% over 8 months of implementation. MOST completion was associated with a significant decrease in discordance between patients’ wishes and documented goals of care. Patients with a MOST were significantly older and had a higher charlson comorbidity score than those without a MOST. Despite this, there was no difference in the number of days study patients were admitted to hospital within 90 days of study inclusion.

Conclusions MOST implementation improves the frequency and quality of inpatient ACP documentation with no effect on acute care utilisation.

  • advance care planning
  • quality improvement
  • prospective study

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  • Contributors RN and SK lead the study. SK acquired funding, designed the study and aided in implementation. RN assisted in study design, oversaw implementation and managed the projects daily operations. RN and SK wrote and revised the manuscript.

  • Funding This study was funded by the Comox Valley Auxillary Society, Division of Family Practice, and Healthcare Foundation, and the Doctors of BC.

  • Competing interests None declared.

  • Ethics approval St. Joseph's General Hospital Ethics Committee AND The Vancouver Island Health Authority Ethics Committee.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information

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