Impact of a Comprehensive End of Life Admission Order Set On Clinician Self-Rated Care Proficiency.

CONTEXT: High-quality end-of-life (EOL) care is essential to ensure comfort, dignity, and goal-concordant care. Despite its importance, variability in practice and clinician-reported challenges with preparedness and guidance persist. Electronic health record (EHR) based order sets may standardize EOL care, but their impact across settings is not well defined. OBJECTIVES: Assess the impact of a comprehensive order-set on provider proficiency with EOL care. METHODS: Clinician perceptions of satisfaction with EOL guidance, preparedness for care delivery, and ease of order process were assessed pre-and post-implementation of an electronic EOL admission order set at St. Jude Children's Research Hospital. Comparison between baseline (T1) and post-implementation (T2) responses used chi-square or Fisher's exact tests and ordinal logistic regression. McNemar's test, Stuart-Maxwell test, and mixed‑effects ordinal logistic regression were utilized for retrospective response analysis. RESULTS: A total of 340 survey responses were analyzed (T1:n=197; T2:n=143). Implementation was associated with significant improvements in satisfaction with EOL guidance among prescribers (including physicians and advanced practice providers) (very satisfied:10.9% → 33.9%, p=0.004) and nurses (7.1% → 19.7%, p=0.028). Nurses reported substantial increases in preparedness (very prepared:14.2% → 53.0%, p<0.001). Prescribers reported greater ease in placing and following EOL orders (OR=2.81; 95% CI:1.82-4.37; p<0.001). Retrospective assessment at T2 demonstrated higher satisfaction after implementation than before (OR=2.39; 95% CI:1.44-3.97; p=0.001). Improvements were consistent across roles and experience levels. CONCLUSIONS: Implementation of a standardized EOL admission order set can improve clinician reported satisfaction, perceived preparedness, and workflow efficiency in EOL care processes, which may result in enhanced EOL care delivery.