What Is The Goal of Care for This Patient? Documenting and Communicating Patient Goals of Care across Teams in ICU (QI820)

Abstract

•Describe challenges to provide care that is concordant with patient goal of care in intensive care setting.•Discuss process and strategies to develop and implement new documentation practice to different teams.•Discuss how to promote better communications about patient’s goal of care across multiple teams working in ICU settings. Providing goal concordant care in ICU settings can be challenging. Clinical status of patients fluctuates daily, often hourly, thus treatment options and goals of care could change accordingly. Complex conditions require involvement of multiple specialists and teams, and understanding of the patient’s goals of care may be inconsistent among them. Nurses in an ICU experienced difficulty tracking multiple providers discussing with their patient and/or families and resulting goals of care decisions. An ICU team initiated a quality improvement project aimed to create and implement a system for consistent documentation of goals of care conversations (GOCC) that are easily accessible to all health care team members via the electronic health record (EHR). The primary stakeholders for this project were the nurses, intensivists, heart failure team, and palliative care team. In the past, providers used different methods and location in the EHR to document GOCC. We identified the Advance Care Planning (ACP) tab in our EHR as a central location for all ACP-related information including GOCC. Informatics partner created a note template to document GOCC with a function to “grab and insert” the GOCC note into the ACP tab. Using the note template, GOCC notes consistently appear in the ACP tab and are easily seen by all team members with 1-click in one location in a patient EHR. Following pilot test of the note template use in each team, it was disseminated to other providers as a best practice for GOCC documentation. Development of a documentation system that fits the workflow of different teams was a key to facilitate better communication across teams. Better documentation and communication about GOCCs increase the opportunity to have meaningful GOCC with patients and likelihood to provide goal concordant care.