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Background and Aim This QI initiative, with the aim to increase the completion rate of referred ACP discussions from the current 50% to 80% within a six-month period, was conducted in the Low Clearance Clinic (LCC), National University Hospital. The LCC functions provide specialized care for patients with advanced CKD and ESKD.The target patient group includes individuals diagnosed with eGFR <20 mL/min, and ages above 60 years old. ACP discussions, where Goals of Care (GoC) are explored and documented, are strongly encouraged.Problem Identified Patients and families lacked readiness to discuss GoCPatients at LCC were aged 60 and above, and they indicated preference to have their families to be present during ACP discussionPatients often deprioritize ACP if they are not conducted on the same day as their follow-up appointmentKey Actions Introduced Doctors and nurses will introduce and counsel both patients and their families about GoC, emphasizing the importance of discussing and documenting their personal values, life goals, and medical treatment preferencesPatients and families will then be informed that ACP Care Coordinators will facilitate the GoC documentation at the next follow-up appointmentEncourage involvement of the families of patients, given that the target patient group is elderlyPatients and families who demonstrate readiness to engage in ACP discussions will be labelled as ‘ACP Ready’ in the EMR, at least one week before their follow-up appointmentThis informs ACP Care Coordinators in advance, and allows allocation of adequate manpower accordinglyThis seamless same-day transition aimed to minimise patient loss, reduce drop-off rates, and improve ACP completionEarly Results and Observations Following the implementation at LCC, we observed:ACP completion rate has achieved a stunning 100%, representing a 2-fold improvement over the hospital-wide baseline of 50%Time taken per ACP discussion has reduced to an average of 45–60 minutes, reflecting a 50% efficiency gainLessons Learned Engagement of patients and families is key as the latter is often double hatting as the caregiversSeamless integration into existing workflows is to minimise adjustments, making them easy to adopt with minimal disruption, ensuring smoother transitions and higher acceptance from healthcare teamsEffective use of healthcare resources and enhancing quality of careImpact for the Healthcare System as a Whole A replicable model that can be adopted by other institutions, enhancing overall care quality