- Email: [email protected]
A Resident-Led Quality Improvement Program for Increasing Documentation of Advance Care Planning Discussions (FR407-C)
368
Schedule With Abstracts
Result. Quality, relevance, and usefulness have consistently been rated 4.95, 4.925, and 4.975, respectively. 25% of third years have taken the longitudinal elective. Qualitative comments emphasized usefulness of pre-reading, in-class writing, hearing each others’ stories and reading aloud with peer/faculty feedback. Medical residents participating in a similar program have published widely, including the New York Times (2), Health Affairs Narrative Matters, Annals of Internal Medicine, and Huffington Post. Conclusion. Narrative writing is a relevant and useful advocacy tool for medical students and was enthusiastically received by the learners. The first set of trainees is just entering the final phase of the curriculum with anticipated publication preparedness.
Implications for Research, Policy, or Practice. Training medical students to critically analyze as well as articulately voice their experiences and perspectives on health and healthcare may have a profound impact on how policy is crafted, enhance career options, and improve job satisfaction. Opportunities to expand public medical writing training programs abound.
A Resident-Led Quality Improvement Program for Increasing Documentation of Advance Care Planning Discussions (FR407-C) Joshua Lakin, MD, University of California at San Francisco, San Francisco, CA. Elizabeth Le, MD, Palo Alto Veterans Affairs Medical Center, Palo Alto, CA. Harry Hollander University of California at San Francisco, San Francisco, CA. Michelle Mourad University of California at San Francisco, San Francisco, CA. Sumant Ranji University of California at San Francisco, San Francisco, CA. Krishan Soni, MD MBA, University of California at San Francisco, San Francisco, CA. Wendy Anderson, MD MS, University of California at San Francisco, San Francisco, CA. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Describe the design of a resident-led quality improvement program that included a financial incentive to increase rates of
Vol. 45 No. 2 February 2013
documentation of advance care planning discussions in the medical record. 2. Detail the effects of the intervention on rates of documentation of advance care planning discussions. 3. Identify key components that contributed to the program’s success. Background. Advance care planning (ACP) discussions ensure that end of life care is in accord with patients’ preferences. Inconsistent documentation of inpatient discussions puts patients at risk for unwanted interventions after discharge. Research Objectives. To design and implement a resident-led quality improvement program including a financial incentive to ensure that the results of inpatient ACP discussions are available across care transitions. Method. In response to frustration about inconsistent documentation of ACP discussions, two internal medicine residents, in coordination with program faculty, designed a multimodal quality improvement project to encourage residents to assess and document patients’ wishes for end of life care. A field was incorporated into the electronic discharge summary template for residents to document details of ACP discussions occurring during admission. We set a goal for residents to document discussions in the template for 75% of discharged patients. The program included: 1) financial incentive of $400 dollars per resident if goal reached from July 1st, 2011 to May 31st, 2012; 2) providing real time biweekly email feedback about individual rates of completion; 3) monthly education at chief resident orientations and quality improvement conferences. Result. Rates of successful completion increased from 21% to around 90% over the course of the program. Key factors contributing to program success included the resident-led nature of the project, frequent audit and feedback, and the financial incentive. Assessment of sustainability is ongoing. Conclusion. A resident-led quality improvement program including a financial incentive resulted in significant increases in the documentation of ACP discussions in an easy location for outpatient and inpatient providers to locate across care transitions.
Implications for Research, Policy, or Practice. Documenting ACP discussions in a single section of the electronic medical record is
Vol. 45 No. 2 February 2013
Schedule With Abstracts
a straightforward way to ensure that patients’ wishes are accessible across care transitions. Actively engaging and incentivizing physicians in efforts to improve documentation of ACP discussions is key to success.
SIG Symposium Cultivating Grass Roots in Drought Condition: Enhancing Palliative Care in Safety Net Hospitals Through a Statewide Initiative (FR408) Safety Net SIG Karen Contreras, MSN RN OCN PHN, City of Hope, Duarte, CA. Anne Kinderman, MD, San Francisco General Hospital, San Francisco, CA. Betty Ferrell, PhD MA FAAN FPCN CHPN, City of Hope, Duarte, CA. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Describe the unique demographics of patients who receive care in safety net hospitals. 2. Identify two major barriers to expanding palliative care services in these hospitals. 3. Identify the major components of a statewide educational initiative to improve nursing education and leadership in palliative care and discuss how they might be implemented in similarly under-resourced settings. As the numbers of medically uninsured rise, more and more Americans are depending on safety net hospitalsdhospitals responsible for the care of the uninsured and underinsured. The Center to Advance Palliative Care has found that far fewer public hospitals report palliative care services, compared to similarly-sized notfor-profit hospitals. While the development of dedicated palliative care services is an important way to enhance palliative care in public hospitals, safety net providers may need to develop alternative strategies in these under-resourced settings. In this session, members of the interdisciplinary team will describe a comprehensive, statewide initiative to enhance palliative care education and leadership in all 17 of California’s acute care safety net hospitals. Additionally, the presenters will: (a) describe the unique demographic challenges of providing palliative care in safety net institutions, (b) provide a model
369
for expanding palliative care through unit-based palliative care champions, and (c) review 1-year post-course data from a privately-funded California public hospital initiative to enhance nursing education and leadership in palliative care. After reviewing the results of the California initiative, participants will be invited to develop action plans for enhancing education and leadership in diverse settings throughout the United States.
Interdisciplinary Cases (FR409) 2:15e3:15 pm
Concurrent Sessions Care of the Patient Approaching Brain Death (FR410) Robert Smeltz, MA RN NP ACHPN, New York University School of Medicine/Bellevue Hospital, New York, NY. Susan Cohen, MD, Bellevue Hospital Center/New York University, New York City, NY. Dana Robin Lustbader, MD FCCM FCCP FAAHPM, North Shore University Hospital, Manhasset, NY. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Discuss the basic elements involved with brain death determination. 2. Describe the process of organ donation after cardiac death and brain death. 3. Demonstrate best practices in communicating a brain death diagnosis using role-play. Palliative care teams are increasingly becoming involved with the care of patients approaching brain death. Families have a difficult time understanding the concept of, and healthcare providers often have misconceptions about, brain death, therefore, effective communication is essential. Palliative care providers can utilize best practices in communication and avoid the pitfalls that are common in brain death notification. Effective communication and education have been shown to help families process complex medical information and also help with the bereavement period. Recent studies with bereaved family members of patients diagnosed
Schedule With Abstracts
Result. Quality, relevance, and usefulness have consistently been rated 4.95, 4.925, and 4.975, respectively. 25% of third years have taken the longitudinal elective. Qualitative comments emphasized usefulness of pre-reading, in-class writing, hearing each others’ stories and reading aloud with peer/faculty feedback. Medical residents participating in a similar program have published widely, including the New York Times (2), Health Affairs Narrative Matters, Annals of Internal Medicine, and Huffington Post. Conclusion. Narrative writing is a relevant and useful advocacy tool for medical students and was enthusiastically received by the learners. The first set of trainees is just entering the final phase of the curriculum with anticipated publication preparedness.
Implications for Research, Policy, or Practice. Training medical students to critically analyze as well as articulately voice their experiences and perspectives on health and healthcare may have a profound impact on how policy is crafted, enhance career options, and improve job satisfaction. Opportunities to expand public medical writing training programs abound.
A Resident-Led Quality Improvement Program for Increasing Documentation of Advance Care Planning Discussions (FR407-C) Joshua Lakin, MD, University of California at San Francisco, San Francisco, CA. Elizabeth Le, MD, Palo Alto Veterans Affairs Medical Center, Palo Alto, CA. Harry Hollander University of California at San Francisco, San Francisco, CA. Michelle Mourad University of California at San Francisco, San Francisco, CA. Sumant Ranji University of California at San Francisco, San Francisco, CA. Krishan Soni, MD MBA, University of California at San Francisco, San Francisco, CA. Wendy Anderson, MD MS, University of California at San Francisco, San Francisco, CA. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Describe the design of a resident-led quality improvement program that included a financial incentive to increase rates of
Vol. 45 No. 2 February 2013
documentation of advance care planning discussions in the medical record. 2. Detail the effects of the intervention on rates of documentation of advance care planning discussions. 3. Identify key components that contributed to the program’s success. Background. Advance care planning (ACP) discussions ensure that end of life care is in accord with patients’ preferences. Inconsistent documentation of inpatient discussions puts patients at risk for unwanted interventions after discharge. Research Objectives. To design and implement a resident-led quality improvement program including a financial incentive to ensure that the results of inpatient ACP discussions are available across care transitions. Method. In response to frustration about inconsistent documentation of ACP discussions, two internal medicine residents, in coordination with program faculty, designed a multimodal quality improvement project to encourage residents to assess and document patients’ wishes for end of life care. A field was incorporated into the electronic discharge summary template for residents to document details of ACP discussions occurring during admission. We set a goal for residents to document discussions in the template for 75% of discharged patients. The program included: 1) financial incentive of $400 dollars per resident if goal reached from July 1st, 2011 to May 31st, 2012; 2) providing real time biweekly email feedback about individual rates of completion; 3) monthly education at chief resident orientations and quality improvement conferences. Result. Rates of successful completion increased from 21% to around 90% over the course of the program. Key factors contributing to program success included the resident-led nature of the project, frequent audit and feedback, and the financial incentive. Assessment of sustainability is ongoing. Conclusion. A resident-led quality improvement program including a financial incentive resulted in significant increases in the documentation of ACP discussions in an easy location for outpatient and inpatient providers to locate across care transitions.
Implications for Research, Policy, or Practice. Documenting ACP discussions in a single section of the electronic medical record is
Vol. 45 No. 2 February 2013
Schedule With Abstracts
a straightforward way to ensure that patients’ wishes are accessible across care transitions. Actively engaging and incentivizing physicians in efforts to improve documentation of ACP discussions is key to success.
SIG Symposium Cultivating Grass Roots in Drought Condition: Enhancing Palliative Care in Safety Net Hospitals Through a Statewide Initiative (FR408) Safety Net SIG Karen Contreras, MSN RN OCN PHN, City of Hope, Duarte, CA. Anne Kinderman, MD, San Francisco General Hospital, San Francisco, CA. Betty Ferrell, PhD MA FAAN FPCN CHPN, City of Hope, Duarte, CA. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Describe the unique demographics of patients who receive care in safety net hospitals. 2. Identify two major barriers to expanding palliative care services in these hospitals. 3. Identify the major components of a statewide educational initiative to improve nursing education and leadership in palliative care and discuss how they might be implemented in similarly under-resourced settings. As the numbers of medically uninsured rise, more and more Americans are depending on safety net hospitalsdhospitals responsible for the care of the uninsured and underinsured. The Center to Advance Palliative Care has found that far fewer public hospitals report palliative care services, compared to similarly-sized notfor-profit hospitals. While the development of dedicated palliative care services is an important way to enhance palliative care in public hospitals, safety net providers may need to develop alternative strategies in these under-resourced settings. In this session, members of the interdisciplinary team will describe a comprehensive, statewide initiative to enhance palliative care education and leadership in all 17 of California’s acute care safety net hospitals. Additionally, the presenters will: (a) describe the unique demographic challenges of providing palliative care in safety net institutions, (b) provide a model
369
for expanding palliative care through unit-based palliative care champions, and (c) review 1-year post-course data from a privately-funded California public hospital initiative to enhance nursing education and leadership in palliative care. After reviewing the results of the California initiative, participants will be invited to develop action plans for enhancing education and leadership in diverse settings throughout the United States.
Interdisciplinary Cases (FR409) 2:15e3:15 pm
Concurrent Sessions Care of the Patient Approaching Brain Death (FR410) Robert Smeltz, MA RN NP ACHPN, New York University School of Medicine/Bellevue Hospital, New York, NY. Susan Cohen, MD, Bellevue Hospital Center/New York University, New York City, NY. Dana Robin Lustbader, MD FCCM FCCP FAAHPM, North Shore University Hospital, Manhasset, NY. (All authors listed above had no relevant financial relationships to disclose.) Objectives 1. Discuss the basic elements involved with brain death determination. 2. Describe the process of organ donation after cardiac death and brain death. 3. Demonstrate best practices in communicating a brain death diagnosis using role-play. Palliative care teams are increasingly becoming involved with the care of patients approaching brain death. Families have a difficult time understanding the concept of, and healthcare providers often have misconceptions about, brain death, therefore, effective communication is essential. Palliative care providers can utilize best practices in communication and avoid the pitfalls that are common in brain death notification. Effective communication and education have been shown to help families process complex medical information and also help with the bereavement period. Recent studies with bereaved family members of patients diagnosed