Patient Safety Awareness Week (March 14-20) is a chance to highlight important discussions and inspire action to improve the safety of the healthcare system. It is also an opportune time to reflect on how advance care planning ensures individuals’ end-of-life care preferences are discussed, documented and accessible at the point of care. This will help drive safe treatment and reduce harm.

Most Americans overwhelmingly prefer to pass away peacefully and want to avoid aggressive interventions at the end-of-life. Studies have shown that approximately 80 percent of Americans would prefer to die at home. In contrast, our current healthcare system is geared toward a conveyor-belt approach to end-of-life care, with clear referral pathways and processes in place to pursue largely curative interventions, rather than comfort-focused care. Without a clear advance care plan, most people receive more aggressive, invasive and prolonged care than desired.

The Impact of the Pandemic

Providing goal-concordant care is more important than ever amid the COVID-19 pandemic, as elderly individuals and those with chronic conditions are among those at the highest risk of developing severe, life-threatening infections. Without an accurate, complete and accessible advance care plan in place, infected individuals are extremely vulnerable to receiving aggressive treatment. Unless stated otherwise, they will end up on ventilators, many times causing more damage than good.

Prioritizing Advance Care Planning Conversations

Eighty-four percent of individuals who are 65 and older have not been asked by their physician to have an advance care planning conversation. While discussions around end-of-life are difficult, when providers, caregivers, loved ones and patients engage in these conversations, people are empowered to make educated healthcare decisions. These dialogues facilitate shared decision-making around end-of-life care, which results in higher satisfaction for all involved and patients receiving appropriate care that aligns with their goals and values.

Making Patient Wishes Accessible Across All Care Settings

For clinicians to ensure goal-concordant care is provided to every individual, every time, advance care planning must also be appropriately captured and accessible throughout the care continuum. Just 31 percent of physicians report that they are very or extremely confident about locating an existing advance care plan within the EHR. When these care plans are not honored by providers, adverse events of both overtreatment and undertreatment occur – which is a patient safety issue and a costly medical error.

When care plans are available, they must be accessed. ‘Wrongful life’ suits are on the rise, as some individuals are claiming that healthcare providers are trying to keep patients alive against their wishes. These lawsuits serve as a necessary wake-up call to the healthcare industry. Medical errors with advance care planning leading to adverse events deserve as much attention as mistakes like wrong-site surgery.

Normalizing Advance Care Planning Conversations

All healthcare organizations must make advance care planning a strategic priority. While talking about death may be an uncomfortable, these conversations often happen too late. The first conversation a patient has with a clinician should not occur when a patient is terminal. It must happen well before this diagnosis.

Given the patient safety and legal ramifications, healthcare organizations also need to take the time to accurately and completely document patients’ wishes in a system that is always accessible. Research shows that when care plans are documented and locatable, 73 percent of patients died in their place of choice. Healthcare organizations leveraging Vynca have also seen and increase in non-hospitals deaths when advance care plans were documented in Vynca.

By adopting Vynca’s comprehensive advance care planning services and solutions, patients are armed with the resources to make informed end-of-life decisions. Clinicians can conduct meaningful advance care planning conversations. Care preferences can be accurately documented and available to patients, their loved ones, and clinicians across all care settings. With immediate availability and confidence in finding these care plans, healthcare organizations can ensure patient safety is a priority for all individuals at the end-of-life.

Ryan Van Wert

Dr. Van Wert is a co-founder and CEO of Vynca. In addition to his role at Vynca, Dr. Van Wert is a part-time Clinical Assistant Professor at Stanford University, where he maintains a small clinical practice.

Prior to Vynca, Dr. Van Wert co-founded AWAIR, Inc., a medical device company focused on reducing complications for critically ill patients, which was acquired by Cook Medical Technologies in 2015.