Medical Staff Pulse Newsletter

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CS-Link Raises the Flag on Advance Care Planning

Does your patient have a life expectancy of less than six months? If so, under the new medical staff standards, physicians are required to attempt to have a conversation on advance care planning and end-of-life wishes, and to document the conversations in CS-Link™ to make the information easily accessible to all healthcare providers, including specialists.

These medical staff standards were developed by a Cedars-Sinai Medicine team led by Isabel Pedraza, MD.

To make this easier, a new CS-Link alert will display if a patient diagnosed with a terminal disease or disorder does not have an advance care plan on file. The alert will not be displayed if the patient has an advance directive.

Current active conditions including cancer, congestive heart failure, liver disease or failure, transplant, dementia and severe pulmonary disease such as COPD will trigger this alert to make physicians aware of the need for advance care planning.

"Too few of our terminally ill patients have their goals of care, values and wishes recorded," said Glenn Braunstein, MD, vice president of Clinical Innovation. "Unfortunately, it is often left to the house staff or ICU faculty to have that conversation, which is less than ideal, since the patient and family may have just met the doctor or doctors.

"It would be much better if the physician with a long-term relationship with the patient had that difficult but necessary conversation in the ambulatory setting before the patient ever becomes an inpatient."

Pedraza agreed. "Though this can be a difficult topic to discuss with patients, initiating this conversation can be beneficial to the physician-patient relationship," she said. "Research has shown that advance care planning is associated with greater patient satisfaction with their personal physician, and this effect is substantial and long lasting. Advance care planning is also associated with less stress and anxiety for patients with chronic illnesses and their families, and can help ease the burden of dealing with a chronic disease."

CS-Link features a template that allows you to more easily document this information. To access this template, please follow these steps:

  • In the patient header on the patient's electronic chart, check to see if the patient has an advance directive on file with Cedars-Sinai.
  • If nothing is flagged, go to "More Activities," then click on "FYI" to add the Advance Directive Planning Flag.
  • Type "adv" in the text box to fill in the Advance Care Planning SmartText.
  • The new FYI displays in the patient header as an Active FYI. Click on the Advance Directive column to see the note. (The Advance Directive FYI may not show up if multiple FYIs are present; using the mouse, place the cursor arrow over the Active FYIs to see them all.)

Once it is documented in the FYI, this conversation will be found in a standardized place in CS-Link, and the FYI note will be seen if a clinician clicks on the Adv Dir column on the patient header.

For more information on this feature, please contact Braunstein at glenn.braunstein@cshs.org.

An alert similar to this will display in CS-Link if a patient diagnosed with a terminal disease or disorder does not have an advance care plan on file.