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

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

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  1. 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

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

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

  4. 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

  5. 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)

  6. 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

  7. Target population

  8. 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

  9. Results • Intervention vs. control (historical)

  10. Results

  11. Challenges • No conference room! • Teamwork • Communication • Variety to clinical situations & family dynamics

  12. 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

  13. 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!

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

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