Operational Excellence

Document Type


Publication Date

Summer 7-18-2019


Operational Excellence

MeSH Headings

Maine, adult internal medicine clinic, workflows, goal, patient, advanced directive, root cause analysis, email compliance


Maine is experiencing an increasing percentage of its population being over 65 years old. Advanced Care Planning (ACP) is an important part of this aging population medical care so those ends of life preferences are known well in advance. An adult internal medicine clinic in a large academic tertiary medical center decided to create a performance improvement project that addressed ACP with embedded workflows.

The goal of this project was to have a minimum of 40% of patients 65 or older have an Advanced Care Directive or Serious Illness Conversation documented in EPIC.

Baseline metrics demonstrated that ACP discussion rates were less than 12%. A root cause analysis demonstrated several reasons for this low percentage. Several countermeasures were instituted to include a KPI that addressed intern/resident education, daily reminders at morning huddles and email reminders that ACP should be included in pre-visit planning.

In the seven months since the start of this performance improvement project, the documented ACP discussion rate increased to 22.2%.

Next steps include continued compliance monitoring, teach providers to review ACP related reports and ongoing data vigilance.