Using touch-based technology to screen patients in the ICU.

Abstract

76 Background: The intensive care unit (ICU) is associated with high mortality rates, significant costs, along with occasionally futile and non-indicated care. Surveys of patients indicate the majority wish to focus on comfort and being at home at the end of life as opposed to the aggressive interventions received in the hospital. Although a small percentage of patients may be awake, medical teams look to the families to provide the direction of care for a patient in the ICU. City of Hope National Medical Center has utilized tablet-based screening of caregivers for years, and now in conjunction with delirium screening has started to roll out tablet-based screening for patients who are awake and do not have delirium. Methods: In parallel with a task force working to assess and address delirium in the hospital, team members from the Department of Supportive Care Medicine and the ICU developed and tested a survey on a tablet-based screening platform. Awake patients are screened for delirium using the confusion assessment method (CAM-ICU). If patients are awake and have a “negative” CAM-ICU, they are provided a tablet to take a five question survey. The questions were written to the sixth grade language level, reviewed by the Patient and Family Advisory Council and non-ICU patients commented on comprehension and emotional response prior to implementation in the ICU. The questions covered topics including orientation, symptoms to be addressed and confidence level in communicating wishes and values. Results: We have successfully administered tablet-based screening for five patients in the ICU, including one on a ventilator with a tracheostomy. Responses are electronically sent to the medical team. By the time of the conference, we will have screened over 50 patients, including patients who are intubated. Conclusions: Assessment of patient wishes and values should be done far before a patient enters the ICU. Unfortunately this does not always occur. This tablet-based screening pilot was a test of concept for feasibility. Although not ideal, capturing a patient’s values and wishes in the ICU has the potential to further assure care plans are individualized, minimize unwanted treatment options and facilitate possible transitions and improved care.