Increasing Serious Illness Conversations In Patients at High Risk of One-Year Mortality Using Improvement Science: A Quality Improvement Study

Authors

Kanishk D. Sharma, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell
Sandip A. Godambe, University of California at Irvine
Prachi P. Chavan, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow
Agatha Parks-Savage, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow
Marissa Galicia-Castillo, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow

ORCID

0000-0003-4022-6605 (Chavan), 0000-0002-0956-7105 (Parks-Savage)

Document Type

Article

Publication Date

2025

DOI

10.3390/healthcare13020199

Publication Title

Healthcare

Volume

13

Issue

2

Pages

199 (1-10)

Abstract

Background: Serious illness conversation (SIC) in an important skillset for clinicians. A review of mortality meetings from an urban academic hospital highlighted the need for early engagement in SICs and advance care planning (ACP) to align medical treatments with patient-centered outcomes. The aim of this study was to increase SICs and their documentation in patients with low one-year survival probability identified by updated Charlson Comorbidity Index (CCI) scores. Methods: This was a quality improvement study with data collected pre- and post-intervention at a large urban level one trauma center in Virginia, which also serves as a primary teaching hospital to about 400 residents and fellows. Patient chart reviews were completed to assess medical records and hospitalization data. Chi square tests were used to identify statistical significance with the alpha level set at Results: Sixty-two patients with high CCI scores were documented, with 16 (25.81%, p = 0.0001) having EOC notes. Patients with documented EOC notes were significantly more likely to change their focus of care, prompting palliative care (63.04% vs. 50%, p = 0.007) and hospice consults (93.48% vs. 68.75%, p = 0.01), compared to those without. Post-intervention surveys revealed that although 50% of providers conducted SICs, fewer used EOC notes for documentation. Conclusion: This initial intervention suggests that the documentation of SICs increases engagement in ACP, palliative care, hospice consultations, and do not resuscitate decisions.

Rights

© 2025 by the authors.

This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International (CC BY 4.0) License.

Data Availability

Article states: "Patient data cannot be made available due to privacy concerns as they may contain patient health information."

Original Publication Citation

Sharma, K. D., Godambe, S. A., Chavan, P. P., Parks-Savage, A., & Galicia-Castillo, M. (2025). Increasing serious illness conversations in patients at high risk of one-year mortality using improvement science: A quality improvement study. Healthcare, 13(2), 1-10, Article 199. https://doi.org/10.3390/healthcare13020199

Repository Citation

Sharma, K. D., Godambe, S. A., Chavan, P. P., Parks-Savage, A., & Galicia-Castillo, M. (2025). Increasing serious illness conversations in patients at high risk of one-year mortality using improvement science: A quality improvement study. Healthcare, 13(2), 1-10, Article 199. https://doi.org/10.3390/healthcare13020199