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Abstract

Introduction: Despite a staggering 1 in 5 U.S. patients dying in the ICU and projected growth in the aging population, many critical care providers are not adequately trained or skilled at GOC/EOL focused discussions. To address this issue, we created a novel all-inclusive ICU based GOC/EOL focused program with the goal of providing a multidisciplinary communication approach for families of the critically ill patient. Hypothesis: A multidisciplinary ICU team intervention regarding GOC/EOL communication will enhance the clinical abilities of all critical care providers when discussing GOC/EOL issues and increase ICU staff comfort level, while improving transitions to a comfort care approach. Methods: This study was done at an academic tertiary surgical/trauma 24-bed ICU with an average of 15 deaths per month. An initial survey was circulated amongst the critical care staff for baseline expectations, satisfaction, and understanding of GOC/EOL care. A robust intervention was begun including the creation of a multidisciplinary GOC/EOL team, communication tools for providers, patient family pamphlets, standardized EOL order sets, and formalized didactic sessions (based partly on the EOL Nursing Education Consortium curriculum). Subsequently, the same survey was circulated and compared to baseline data. Results: The intervention was provided to nursing, ancillary staff, housestaff, and attending physicians. It generated heightened interest in improving family communication and provided focal direction to foster this growth. Based on the serial surveys, specific staff improvements were seen in caregiver knowledge regarding ability to promote EOL care and family perceptions regarding GOC communication. Improved congruence between families and healthcare providers regarding decisions over intensity of care were also noted. Conclusions: We created a novel unit based multidisciplinary program for improved EOL/GOC approaches in the critical care setting. A similarly formatted program could be adapted by other ICUs. Benefits of such a program include improving caregivers’ perceptions regarding EOL/GOC issues and fostering critical care team growth.