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A4581 - Improving Goals of Care Meetings in the Intensive Care Unit
Author Block: S. Razvi1, S. Rubino1, B. Digiovine2; 1Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, United States, 2Pulmonary/Critical Care Medicine, Henry Ford Hospital, Detroit, MI, United States.
Background: In the United States, approximately 20% of all deaths occur in the intensive care unit (ICU) each year.Critically ill patients frequently lack decisional capacity and the ability to express their preferences.Decisions regarding goals of care often involve family members.ICU goals of care meeting is a central component of communicating effectively and compassionately with families.A major problem is that family meetings fail to occur in a timely fashion.We designed a Quality Improvement (QI) Project to improve compliance and consistency of goals of care meeting in the ICU.
Methods:The QI project was executed in 4 phases. In all 4 phases the investigators kept a weekly log of patients in the ICU;with patients admitted for 72 hours or greater included in the electronic medical records (EMR) review in 4 week blocks.Improving documentation in a timely and consistent way was the goal.
Phase 1 was the Screening phase in which the EMR was screened to assess the documentation of family meetings for patients with ICU stay of 72 hours or greater for 4 weeks.
Phase 2(First intervention) was introducing a standardized documentation template in EMR for family meetings for physician use.Data was collected for patients for 4 weeks afterwards.
Phase 3(Second Intervention) included standardized documentation (as above) and teaching the ICU physicians the framework of family meeting with educational pocket cards distributed to them.Data was collected for 4 weeks after these interventions.
Phase 4(Third Intervention) the above two interventions and distributing educational pamphlets to patients and families,helping them understand ICU family meetings.Data was collected for 4 weeks these interventions.
All four phases were in successive months with different provider team in each phase.
Results: Categorical data was collected as percentages of ICU family meetings documented. Phase 1 showed documentation of meetings in 21% of the patients admitted. In Phase 2 documentation improved to 57.5%. Phase 3 showed a sustained documentation of 51.2%. In Phase 4 the documentation improved to to 67.25%.
Discussion: National surveys note that physicians and nurse directors of ICUs affirmed the importance of regular meetings but reported that such meetings were not conducted. Barriers to timely family meetings include time shortage, skills, culture, stress and Ill-defined goals. We focused on helping define goals by educating families and physicians. Skills and time management were focused on by giving a framework to conduct and document family meetings. Our interventions successfully improved compliance and consistency of goals of care meetings in the ICU.