A National VA Palliative Care Quality Improvement Project for Improving Intensive Care Unit Family Meetings (ICU-FMs)

Abstract

BackgroundWe sought to increase intensive care unit–family meeting (ICU-FM) documentation in the electronic health record in Veterans Affairs (VA) hospitals. MeasuresPrimary outcomes were proportion of VA decedents with ICU-FM and Bereaved Family Survey–Performance Measure (BFS-PM) scores of “excellent.” InterventionQuality improvement (QI) project, clinical champion, and ICU-FM templates were implemented in nine participating VA facilities. ICU-FMs and BFS-PM were determined in decedents between 2011 and 2018. OutcomesICU-FM increased from 3% to 28% in participating vs. 5% to 6% in nonparticipating facilities over time. Participating facilities were five-fold more likely to have ICU-FMs among ICU decedents (OR = 5.69, [4.45–7.28]). Facility-wide excellent BFS-PM scores increased by 19% in participating vs. nonparticipating facilities at the end of the observation period (OR = 1.19, [1.10–1.30]), but no difference between groups was observed in patients who died in the ICU. ConclusionsIncreasing ICU-FMs is necessary but not sufficient to improve family-reported satisfaction after an ICU death.