Improving Palliative Care Conversations in the Cardiac ICU
Author Information
Author(s): Ushpol Adam, Parsons Colby, Golec Sophia, Frousios Ritsa, Tsega Surafel, Linker Anne S., Ronquillo Maria, Gidwani Umesh
Primary Institution: Icahn School of Medicine at Mount Sinai
Hypothesis
An electronic health record (EHR)-based workflow will increase the rate and timeliness of goals of care conversations in the CICU.
Conclusion
Integrating the Surprise Question into the EHR helped facilitate earlier goals of care conversations for critically ill patients at high mortality risk.
Supporting Evidence
- Patients with SQ answers of 'NO' had a higher frequency of GOC conversations in the intervention period.
- The median age of participants was 72 years.
- ICU interventions were more common in the pilot cohort compared to the implementation cohort.
- Significantly more GOC conversations occurred within 2 days of CICU admission during the intervention.
- The study included 195 admissions to the CICU.
Takeaway
The study found a way to help doctors talk to patients about their care preferences earlier by using a simple question in their computer system.
Methodology
A retrospective, observational, quasi-experimental study comparing GOC conversations before and after implementing the SQ in the EHR.
Potential Biases
The effectiveness of the SQ depends on provider expertise and intuition, which may vary.
Limitations
The intervention may not be transferable to other systems, and the study relied on EHR documentation which may not fully capture the quality of conversations.
Participant Demographics
Median age 72 years; 42.6% female.
Statistical Information
P-Value
.004
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
Want to read the original?
Access the complete publication on the publisher's website