Advance care planning in hospitals

An advance care plan can guide management when a patient is admitted to hospital for acute care. Without clear direction, staff in the emergency department may feel obliged to actively treat a patient when it may not be appropriate; for example, a person with advanced life-limiting illness.

Hospitals generally have systems in place to ascertain whether a patient has an existing advance care plan, or, if appropriate, to initiate advance care planning. They also have processes to record information about appropriate resuscitation measures for a patient, and may require staff to discuss a patient’s goals of care at the time of admission.

Without documentation about the goals of care and appropriate interventions for a patient, clinical decisions about care at the end of life may result in the provision of life-sustaining treatment that is not beneficial or not wanted by the patient. Clinicians need to be clear about who is ultimately responsible for decision-making for a patient. If decision-making responsibility is not clear, patients who are receiving treatment from more than one clinical unit may receive inappropriate interventions.

If advance care planning is initiated in a hospital, it should be followed up after discharge in the hospital outpatient clinic or by the patient’s general practitioner.