Improved advance care planning in geriatric hip and femur fractures

Introduction: Healthcare providers should ask advance care planning (ACP) questions early, especially in the often frail population of geriatric trauma patients. To improve ACP documentation at our institution, we implemented a smart phrase for use in patients over 60 with hip and/or femur fractures. The smart phrase addresses living situations, patient wishes and pre-existing ACP documents. Methods: We completed a retrospective chart review analyzing the prevalence of ACP documentation, its timing (pre or post-operatively), and the service completing it for 1 year pre- and post-implementation. Results: After smart phrase inception, ACP documentation increased from 23.1 % to 91.7 %. Pre-operative documentation increased from 15.1 % to 90.2 % Trauma service frequency of documentation increased from 20.7 % to 92.3 %. Conclusions: There was a significant improvement of ACP documentation pre-operatively and by the primary trauma team with a smart phrase. This increased knowledge of treatment preferences can provide better informed medical decision-making for a high risk population.