Successful Strategies for Operationalizing Goals-of-Care Documentation
Publication Title
NEJM Catalyst
Document Type
Article
Publication Date
5-21-2025
Keywords
washington; renton; institute for human caring
Abstract
Goals-of-care (GOC) conversations are critically important to ensure that clinical teams and health systems know what matters to their patients, enabling treatment plans to be aligned with patients’ goals. However, because many conversations are ad hoc and clinician dependent, patients with serious medical conditions often do not have GOC conversations documented in their health record, either because these conversations did not occur or because they simply were not entered into the health record. The authors present details of a multiyear, systematic effort that contributed to one health system’s substantial increase in the number of documented conversations that met minimum specification criteria across the 51 hospitals involved in the health system’s initiative. Over the period from January 1, 2024, to December 31, 2024, 8,533 out of 10,063 (84.8%) of patients who were in an ICU for 5 or more days had a documented GOC conversation in the electronic health record at some point between hospital admission and prior to the fifth ICU day. This compares with a preintervention rate of just 555 out of 8,143 (6.8%) of patients who were in an ICU for 5 or more days having a documented GOC conversation in the period from January 1, 2016, to December 31, 2016. Essential strategies included centering efforts within the organization’s mission and vision, partnering with clinical leaders to set strong quality standards and corresponding metrics, easing documentation within the electronic health record, and designing and implementing effective communication skills–building workshops.
Specialty/Research Institute
Health Care Administration
DOI
10.1056/CAT.24.0359
