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

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Doctor 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

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Problem: useless care in the ICU What is worthless care? Regular Many causes Poor visualization Sensitive subject, huge impact Multidisciplinary approach required

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Dartmouth Atlas - End of Life - 2006 Jack Wennberg, PhD, Elliott Fisher, PhD

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Aim Broad point: diminish vain care through enhanced basic leadership Specific point: Increase family investment in end-of-life (choices) by means of multidisciplinary family gatherings Rationale: better correspondence  better choices

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Measures of accomplishment % of family cooperation in meeting (& time) % of families de-raising consideration (DNR) ICU length-of-remain for decedents (days preceding demise – purposeless)

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Intervention Multidisciplinary family gatherings inside 24 hours of patient's ICU affirmation Objectives: Discuss clinical condition Determine family's viewpoints, patient's desires Make choices on care Education

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Target populace

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Process Map Identify high-chance patients Assemble group Schedule meeting Discussion layout * Document Introductions Discuss understanding status (Dx, Px, Tx) Determine patient's desires & set up surrogate. Answer questions Develop plan of care & settle on choices Plan on future gatherings

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Results Intervention versus control (authentic)

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Challenges No gathering room! Collaboration Communication Variety to clinical circumstances & family progression

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What we finished Family gathering = some portion of standard of care  vain care *  fulfillment with care Improved nature of EOL care Improved correspondence Developed process & organize for gatherings Education for students LOS 2.3 days Costs: > 5 day assemble (~80) Avoided 184 days saved $847,504

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Lessons Learned No silver shot! Don't realize what we don't know Communication is difficult! Center… center… center… Structure mediation (subtle elements) Successes & disappointments Re-assess… input… modify Not everybody on board More thoughts Benefit to intercession = more than anticipated!

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"… For the key to the care of the patient is in tending to the patient." - Dr. Francis W. Peabody