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How Often Do Medicine Residents Discuss Resuscitation Preferences, Really? (769)
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referring physicians and highlight the need for interventions designed to facilitate physicianpatient communication about palliative care. VI. Implications for research, policy, or practice. Identification of key symptoms that physicians report less comfort in managing represent opportunities for targeted advertising by palliative care teams with expertise in these particular areas. Additionally, identification of a commonly endorsed barrier to patient referral (ie, patient and/or family’s unrealistic expectations about prognosis) provides support for additional research identifying strategies that can help overcome this particular barrier. Furthermore, the majority of physicians in our sample had favorable attitudes about palliative care, suggesting that physicians understand the need for and benefits associated with the delivery of palliative care services in the inpatient setting.
How Often Do Medicine Residents Discuss Resuscitation Preferences, Really? (769) Kristina Newport, MD, Virginia Commonwealth University, Hershey, PA; Jocelyn Wozney, MD, Penn State Hershey Medical Center, Hershey, PA; Cynthia H. Chuang, MD, Penn State Hershey Medical Center, Hershey, PA; Jennifer A. Chambers, MD MBA, Penn State Hershey Medical Center, Hershey, PA Objectives 1. Discuss the discrepancy between internal medicine residents’ perceived frequency of discussing resuscitation preferences with the actual documentation of these discussions in the medical record. 2. Discuss internal medicine residents’ previous training and comfort level with discussing resuscitative preferences. 3. Discuss educational interventions that will ensure consistent, appropriate resident discussions of resuscitation preferences with inpatients. I. Background. Residents are often the first providers to communicate with patients upon admission to academic medical centers. Although residents report discussing resuscitation preferences with most admitted patients, an unpublished chart review at our institution did not confirm this, prompting further study. II. Research Objectives. To compare internal medicine residents’ perceived frequency of discussing resuscitation preferences with frequency of documentation of these discussions in the medical record.
Vol. 37 No.3 March 2009
III. Methods. Internal medicine residents at Penn State Hershey Medical Center completed surveys assessing their learning experiences, practices, and attitudes regarding discussing resuscitation preferences with inpatients. The subset of residents just completing general medicine, intensive care, or hematology/oncology months reported how often they discussed advance directives with inpatients on those services. We reviewed the electronic and paper medical records of all patients discharged from those three services the month prior to the survey to determine actual frequency of resident documentation of resuscitation preferences. IV. Results. Forty-seven of 82 (57%) residents responded. Most residents have received lectures on advance directives (74%) and witnessed attending physicians discuss them (74%). Residents on the medicine, intensive care, or hematology/oncology services reported discussing resuscitation preferences with 85% (60-97.5) of patients they cared for and documenting these preferences 80% (50-100) of the time. Preliminary data from 138 of 340 charts reviewed reveals that they actually document these conversations in the paper or electronic chart less than 40% of the time. The most commonly reported reasons for not discussing preferences were the patient’s situation (51%) and time constraints (32%). Most residents rated their comfort level with discussing advance directives as a 4 on a 5-point scale. V. Conclusions. Internal medicine residents believe that they document discussions of resuscitation preferences more frequently than they actually do. VI. Implications for research, policy, or practice. These findings suggest that medicine residents need improved training in order to consistently discuss and document resuscitation preferences with hospitalized patients.
From Consult to Home—Pediatric Palliative Care as a Medical Home (770) Melody L. Hellsten, MS PNP-BC, University of Texas Health Center, San Antonio, TX Objectives 1. Identify the developmental milestones of a clinical pediatric palliative care service over a 10-year period. 2. Evaluate systems and assess needs related to the ongoing development of a pediatric palliative care program. 3. Initiate system change based on organization-
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referring physicians and highlight the need for interventions designed to facilitate physicianpatient communication about palliative care. VI. Implications for research, policy, or practice. Identification of key symptoms that physicians report less comfort in managing represent opportunities for targeted advertising by palliative care teams with expertise in these particular areas. Additionally, identification of a commonly endorsed barrier to patient referral (ie, patient and/or family’s unrealistic expectations about prognosis) provides support for additional research identifying strategies that can help overcome this particular barrier. Furthermore, the majority of physicians in our sample had favorable attitudes about palliative care, suggesting that physicians understand the need for and benefits associated with the delivery of palliative care services in the inpatient setting.
How Often Do Medicine Residents Discuss Resuscitation Preferences, Really? (769) Kristina Newport, MD, Virginia Commonwealth University, Hershey, PA; Jocelyn Wozney, MD, Penn State Hershey Medical Center, Hershey, PA; Cynthia H. Chuang, MD, Penn State Hershey Medical Center, Hershey, PA; Jennifer A. Chambers, MD MBA, Penn State Hershey Medical Center, Hershey, PA Objectives 1. Discuss the discrepancy between internal medicine residents’ perceived frequency of discussing resuscitation preferences with the actual documentation of these discussions in the medical record. 2. Discuss internal medicine residents’ previous training and comfort level with discussing resuscitative preferences. 3. Discuss educational interventions that will ensure consistent, appropriate resident discussions of resuscitation preferences with inpatients. I. Background. Residents are often the first providers to communicate with patients upon admission to academic medical centers. Although residents report discussing resuscitation preferences with most admitted patients, an unpublished chart review at our institution did not confirm this, prompting further study. II. Research Objectives. To compare internal medicine residents’ perceived frequency of discussing resuscitation preferences with frequency of documentation of these discussions in the medical record.
Vol. 37 No.3 March 2009
III. Methods. Internal medicine residents at Penn State Hershey Medical Center completed surveys assessing their learning experiences, practices, and attitudes regarding discussing resuscitation preferences with inpatients. The subset of residents just completing general medicine, intensive care, or hematology/oncology months reported how often they discussed advance directives with inpatients on those services. We reviewed the electronic and paper medical records of all patients discharged from those three services the month prior to the survey to determine actual frequency of resident documentation of resuscitation preferences. IV. Results. Forty-seven of 82 (57%) residents responded. Most residents have received lectures on advance directives (74%) and witnessed attending physicians discuss them (74%). Residents on the medicine, intensive care, or hematology/oncology services reported discussing resuscitation preferences with 85% (60-97.5) of patients they cared for and documenting these preferences 80% (50-100) of the time. Preliminary data from 138 of 340 charts reviewed reveals that they actually document these conversations in the paper or electronic chart less than 40% of the time. The most commonly reported reasons for not discussing preferences were the patient’s situation (51%) and time constraints (32%). Most residents rated their comfort level with discussing advance directives as a 4 on a 5-point scale. V. Conclusions. Internal medicine residents believe that they document discussions of resuscitation preferences more frequently than they actually do. VI. Implications for research, policy, or practice. These findings suggest that medicine residents need improved training in order to consistently discuss and document resuscitation preferences with hospitalized patients.
From Consult to Home—Pediatric Palliative Care as a Medical Home (770) Melody L. Hellsten, MS PNP-BC, University of Texas Health Center, San Antonio, TX Objectives 1. Identify the developmental milestones of a clinical pediatric palliative care service over a 10-year period. 2. Evaluate systems and assess needs related to the ongoing development of a pediatric palliative care program. 3. Initiate system change based on organization-