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Effect of an Early Family Conference on Decreasing Futile Care in Critically Ill Patients in the ICU PowerPoint Presentation
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Effect of an Early Family Conference on Decreasing Futile Care in Critically Ill Patients in the ICU - PowerPoint PPT Presentation


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Physician Quality and Safety Academy Leading Change to Improve Care. Effect of an Early Family Conference on Decreasing Futile Care in Critically Ill Patients in the ICU. Khalid F. Almoosa, MD, MS Ruthie Siska, RN, MICU Nurse Manager Bela Patel, MD, MICU Director

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slide1

Physician Quality and Safety Academy

Leading Change to Improve Care

Effect of an Early Family Conference on Decreasing Futile Care in Critically Ill Patients in the ICU

Khalid F. Almoosa, MD, MS

Ruthie Siska, RN, MICU Nurse Manager

Bela Patel, MD, MICU Director

Katherine Luther, RN, MPM, Director, Healthcare Improvement

problem futile care in the icu
Problem: futile care in the ICU
  • What is futile care?
  • Common
  • Many causes
  • Poor prognostication
  • Sensitive topic, significant effect
  • Multidisciplinary approach needed
slide4
Aim

Broad aim: reduce futile care through improved decision-making

Specific aim: Increase family participation in end-of-life (decisions) via multidisciplinary family conferences

Rationale: better communication  better decisions

measures of success
Measures of success
  • % of family participation in conference (& time)
  • % of families de-escalating care (DNR)
  • ICU length-of-stay for decedents (days prior to death – futile)
intervention
Intervention
  • Multidisciplinary family conferences within 24 hours of patient’s ICU admission
  • Objectives:
    • Discuss clinical condition
    • Determine family’s perspectives, patient’s wishes
    • Make decisions on care
    • Education
process map
Process Map
  • Identify high-risk patients
  • Assemble team
  • Schedule conference
  • Discussion template*
  • Document
  • Introductions
  • Discuss patient status (Dx, Px, Tx)
  • Determine patient’s wishes & establish surrogate.
  • Answer questions
  • Develop plan of care & make decisions
  • Plan on future meetings
results
Results
  • Intervention vs. control (historical)
challenges
Challenges
  • No conference room!
  • Teamwork
  • Communication
  • Variety to clinical situations & family dynamics
what we accomplished
What we accomplished
  • Family conference = part of standard of care
  •  futile care*
  •  satisfaction with care
    • Improved quality of EOL care
  • Improved communication
  • Developed process & format for meetings
  • Education for trainees
  • LOS 2.3 days
  • Costs: > 5 day group (~80)
  • Avoided 184 days
  • saved $847,504
lessons learned
Lessons Learned
  • No silver bullet!
  • Don’t know what we don’t know
  • Communication is not easy!
  • Focus…focus…focus…
  • Structure intervention (details)
  • Successes & failures
  • Re-evaluate…feedback…revise
  • Not everyone on board
  • More ideas
  • Benefit to intervention = more than expected!
for the secret to the care of the patient is in caring for the patient dr francis w peabody

“…For the secret to the care of the patient is in caring for the patient.”- Dr. Francis W. Peabody