End of life: A focus upon making doing the right thing easier in challenging conversations.

Abstract

174 Background: Communication surrounding end of life decisions is difficult for patients and their loved ones as well as the clinicians involved in their care. An audit of end of life measures brought to light an area of opportunity across a national network of five geographically dispersed medical centers that resulted in a quality improvement project which sought to enhance communication processes among clinicians and patients. Methods: Utilizing principals of complexity theory, a multidisciplinary task force developed a communication tool to guide clinicians in discussions with patients and improved upon the electronic health record (EHR) to make documentation clearer, easier and more meaningful. “Words that Matter” with scenarios and suggestions for clinicians to introduce palliative care or hospice to patients were established. EHR enhancements included structured fields for hospice discussion and referral based upon network defined objective clinical criteria. A hospice referral field was also created to allow physicians to place an order along with discontinuing chemotherapy without leaving the note. Education was provided to clinicians in various formats. Implementation occurred early fall 2017. Results: Structured fields allow for easier electronic data pulls for reports to measure process improvement and communication. Outcome measures of interest include: chemotherapy administered in the last 14 days of life and timeliness of referral to hospice. Additional process metrics are in place to measure utilization of supporting resources. Conclusions: Effective communication of end of life issues and timely hospice referral is an integral part of care. Communication tools and criteria prompt our physicians to engage in discussions and refer patients earlier in their journey, when appropriate. Providing structured fields in the EHR has made documentation more complete.[Table: see text]