Increasing the Uptake of Advanced Care Planning amongst Patients with End Stage Liver Disease
Care Continuum
Care Process & Redesign
National Healthcare Group Quality Improvement
National Healthcare Group
24 December 2025
To increase the uptake of Advanced Care Planning (ACP) amongst patients with End Stage Liver Disease (ESLD) admitted to the. The intervention shows promise for improving ACP uptake among ESLD patients, with significant cost savings and increased ACP.
Year Submitted: 2025
Published Date: 24 December 2025
Tags: Care Process ＆ Redesign, Workflow Redesign, Cost Saving, Quality Improvement, Productivity, Care Continuum, End-Of-Life Care
About this Content
Aims
To increase the uptake of Advanced Care Planning (ACP) amongst patients with End Stage Liver Disease (ESLD) admitted to the Gastroenterology General Ward from 40% to 70% in 6 months.
Background
Patients with end-stage liver disease have frequent admissions to Gastroenterology with high in-hospital morbidity and mortality. Many are elderly and non-transplant candidates. ACP discussions regarding goals of care often do not occur until the end of life for these patients.
Methods
The methodology includes introductory briefings to all GE MOs, educational updates, empowering primary physicians to conduct serious illness discussions, scheduling reviews with stakeholders, and future interventions to expand ACP reach to other cohorts.
Results
Improvement in ACP completion rate after CPIP increased from 20% to 40%. The estimated number of patients per year admitted to Gastroenterology with end-stage liver disease is 396. Additional ACPs per year as a result of CPIP is 79. Expected annual cost savings due to reduction in patients admitted undergoing endoscopy or ICU admissions is significant.
Conclusion
The intervention shows promise for improving ACP uptake among ESLD patients, with significant cost savings and increased ACP discussions.
Lessons Learnt
Difficulties with data collection were encountered, and patients/NOK require time to decide about ACP, often not completed inpatient, leading to outpatient follow-up in ACP clinic.
Keywords
Advanced Care Planning, End Stage Liver Disease, Gastroenterology
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital |
Platform(s) | National Healthcare Group Quality Improvement |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Gastroenterology |
Project Lead(s) | Lin Huiyu, Chen Kok Pun |
Project Member(s) | Kalaiyarasi Kaliyaperumal |
Connect with this contributor!
Group Quality - nhggroup.QRM@nhghealth.com.sg