226 Background: Advance care planning is often initiated too late, which leads to added stress and high resource utilization at the end of life which is contrary to many patients’ wishes. Ideally, discussing patient’s wishes should start early. An advance directive (AD) documents patient preferences for end-of-life care. Methods: In order to improve this process, the team used the DMAIC process: Define, Measure, Analyze, Improve, and Control. In the define phase, 79 new cancer diagnosis patients’ medical records were reviewed and completed. This revealed that 25.58% of these patients claim to have an AD, but only 5% have an AD documented in their record within 30 days of their first visit. Upon further discussion with staff, there was no standard process. The focus performance metric for the project was to have the AD in the chart within 30 days of their first visit. Goal was set at 20%. Analyzing the process was as follows: Process map, Fishbone diagram to determine potential improvements. Priority pay-off matrix. The most effective process change would be to add a notice in the new patient packet for the patient to bring their AD with them to their first visit. Results: The first iteration of the improve phase included the notice created in the analyze phase. After completion, 60% of patients had an AD in their chart within 30 days of their first visit. For the second iteration, the team worked with psychology staff to create a letter to the patient explaining the advantages of having an AD in the chart. Results were 100% of the performance improvement metric. Controlling this process change is simple, but continuing a 100% target is difficult. Some patients who do not have an AD in their chart feel uncomfortable with it or do not understand what it is. Future improvements include patient education processes and provider discussions with the patients to ensure an 80% target is maintained. Conclusions: The team learned developing and communicating a formal process is imperative to achieving the target. Also important is to communicate clearly with the patients, enabling them to understand what (and why) their provider needs from them.
Cerebral Ischemia and Reperfusion Increases the Heterogeneity of Local Oxygen Supply/Consumption Balance
