Spiritual care support of goal concordant care in the oncologic emergency setting.

Abstract

274 Background: Many patients admitted through emergency departments are near the end of life. Patients who have previously indicated that they do not wish for advanced resuscitation efforts are often admitted to the hospital with a presumption of full code status. Documentation of goals of care discussions (GOC) increases the likelihood of receiving goal concordant care during the ensuing hospitalization. In the fast-paced environment of emergency care, physicians often hesitate to introduce these critical conversations. Healthcare has evolved beyond the physician–patient dyad, it includes a variety of professions. A multi-disciplinary team including physicians, nursing, social work, and spiritual care providers (SCPs) was established to improve compliance of documenting goals of care. Methods: This quality improvement project was initiated in the institution's Acute Cancer Care Center. SCPs, a previously underutilized resource, were enlisted to assist in GOC discussions and advance care planning (ACP) documentation on patients who had previously elected do not resuscitate/do not intubate (DNR/DNI) status. The goal was to increase ACP documentation for these patients by 50% over baseline. The project employed a Plan-Do-Study-Act technique. Patients who had a history of DNR/DNI were automatically identified upon arrival to emergency care based on any of 4 criteria extracted from the electronic medical record: 1) History of DNR order within the past year; 2) advance care plan notes documenting the patient is not “full code”; 3) out of hospital DNR; and 4) previous discharge to hospice. Track boards were updated across multiple disciplines (attending physicians, SCPs, nursing and social work) to identify these patients. SCPs rounded on identified patients who were expected to be admitted based on discussions with nurses/attending physicians. They met with patients to provide support while confirming/updating their goals of care. This allowed attending providers to more easily confirm the patient’s wishes and place appropriate documentation/orders. The project took place during May 2023, using April 2023 as baseline data. Results: The goal of a 50% increase in ACP compliance was exceeded. In the month of April, 25 of 131 identified patients had ACP notes. In May 55 of 151 identified patients had ACP documentation. This represents a relative 89% increase in ACP documentation. An increase in DNR orders was also noted (table). Conclusions: SCPs can serve as a resource for establishing and documenting goals of care for patients in the emergency care setting. Collaborating with SCPs can increase compliance with local and national GOC initiatives.[Table: see text]