Advance Directive Initiative in the Intensive Care Unit

Abstract

SESSION TITLE: Education, Research, and Quality Improvement SESSION TYPE: Original Investigation Slide PRESENTED ON: Sunday, October 25, 2015 at 07:30 AM - 08:30 AM PURPOSE: Advance directive (AD) is an important part of healthcare decision making. It allows patients to express their wishes regarding their medical care choices and determine who will make such decisions when they are unable to. Often, patients admitted to the intensive care unit (ICU) have limited ability to participate in medical decisions. Hence, there is a need to initiate goals of care discussion as early as possible. This project was conceived to increase AD discussion and documentation within 72 hours of ICU admission. Goals of care discussion establish individualized healthcare and would potentially increase patient satisfaction. METHODS: We conducted a quality improvement project at the Mayo Clinic Methodist Hospital ICU from September 2014 until January 2015 to improve AD discussion and documentation within the first 72 hours of admission. Using the define, measure, analyze, improve and control (DMAIC) framework, baseline data (discussion, documentation and number of patients with existing AD) was collected. Interventions included distribution of educational materials, having project members as resources and leads in the ICU, and regular weekly feedback to the healthcare team were utilized to increase the engagement of the stakeholders. RESULTS: There were a total of 128 unique admissions in September 2014 which were included in the baseline data collection. Only 22% (N=22) had AD on admission and 12% (N=15) of admission had documentation of the AD discussion. Study intervention followed for 3 months and post-intervention data was collected. Results show a total of 170 unique admissions from November 2014 to January 2015, AD on admission increased to 40% (N=68) and 39% (N=66) had AD discussion documented within 72 hours of admission to the ICU. CONCLUSIONS: Our interventions helped increase AD discussion documentation within 72 hours of admission to the ICU from a baseline of 12% to 39% after 3 months. Education is an important tool to encourage healthcare providers to discuss advance care planning with their patients. After the implementation of multidisciplinary approach (providing educational resources, regular feedback to the healthcare team, and having dedicated healthcare personnel to address AD status), the engagement increased considerably. CLINICAL IMPLICATIONS: In the critically ill population, having a timely advanced care discussion will provide a more patient-centered approach and potentially improve the relationship among the patient, family members and healthcare team. DISCLOSURE: The following authors have nothing to disclose: Suartcha Prueksaritanond, Hon Tan, Perliveh Carrera, Prashant Jagtap, Andrea New, Claudia Anderson, Kianoush Banaei Kashani No Product/Research Disclosure Information