Interdisciplinary Team Meetings Research Articles

Effectiveness of comprehensive geriatric assessment intervention on quality of life, caregiver burden and length of hospital stay: a systematic review and meta-analysis of randomised controlled trials

BackgroundComprehensive geriatric assessment (CGA) interventions can improve functional ability and reduce mortality in older adults, but the effectiveness of CGA intervention on the quality of life, caregiver burden, and length of hospital stay remains unclear. The study aimed to determine the effectiveness of CGA intervention on the quality of life, length of hospital stay, and caregiver burden in older adults by conducting meta-analyses of randomised controlled trials (RCTs).MethodsA literature search in PubMed, Embase, and Cochrane Library was conducted for papers published before February 29, 2020, based on inclusion criteria. Standardised mean difference (SMD) or mean difference (MD) with 95% confidence intervals (CIs) was calculated using the random-effects model. Subgroup analyses, sensitivity analyses, and publication bias analyses were also conducted.ResultsA total of 28 RCTs were included. Overall, the intervention components common in different CGA intervention models were interdisciplinary assessments and team meetings. Meta-analyses showed that CGA interventions improved the quality of life of older people (SMD = 0.12; 95% CI = 0.03 to 0.21; P = 0.009) compared to usual care, and subgroup analyses showed that CGA interventions improved the quality of life only in participants’ age > 80 years and at follow-up ≤3 months. The change value of quality of life in the CGA intervention group was better than that in the usual care group on six dimensions of the 36-Item Short-Form Health Survey questionnaire (SF-36). Also, compared to usual care, the CGA intervention reduced the caregiver burden (SMD = − 0.56; 95% CI = − 0.97 to − 0.15, P = 0.007), but had no significant effect on the length of hospital stay.ConclusionsCGA intervention was effective in improving the quality of life and reducing caregiver burden, but did not affect the length of hospital stay. It is recommended that future studies apply the SF-36 to evaluate the impact of CGA interventions on the quality of life and provide supportive strategies for caregivers as an essential part of the CGA intervention, to find additional benefits of CGA interventions.

Patient Monitoring Alarms in an Intensive Care Unit: Observational Study With Do-It-Yourself Instructions.

BackgroundAs one of the most essential technical components of the intensive care unit (ICU), continuous monitoring of patients’ vital parameters has significantly improved patient safety by alerting staff through an alarm when a parameter deviates from the normal range. However, the vast number of alarms regularly overwhelms staff and may induce alarm fatigue, a condition recently exacerbated by COVID-19 and potentially endangering patients.ObjectiveThis study focused on providing a complete and repeatable analysis of the alarm data of an ICU’s patient monitoring system. We aimed to develop do-it-yourself (DIY) instructions for technically versed ICU staff to analyze their monitoring data themselves, which is an essential element for developing efficient and effective alarm optimization strategies.MethodsThis observational study was conducted using alarm log data extracted from the patient monitoring system of a 21-bed surgical ICU in 2019. DIY instructions were iteratively developed in informal interdisciplinary team meetings. The data analysis was grounded in a framework consisting of 5 dimensions, each with specific metrics: alarm load (eg, alarms per bed per day, alarm flood conditions, alarm per device and per criticality), avoidable alarms, (eg, the number of technical alarms), responsiveness and alarm handling (eg alarm duration), sensing (eg, usage of the alarm pause function), and exposure (eg, alarms per room type). Results were visualized using the R package ggplot2 to provide detailed insights into the ICU’s alarm situation.ResultsWe developed 6 DIY instructions that should be followed iteratively step by step. Alarm load metrics should be (re)defined before alarm log data are collected and analyzed. Intuitive visualizations of the alarm metrics should be created next and presented to staff in order to help identify patterns in the alarm data for designing and implementing effective alarm management interventions. We provide the script we used for the data preparation and an R-Markdown file to create comprehensive alarm reports. The alarm load in the respective ICU was quantified by 152.5 (SD 42.2) alarms per bed per day on average and alarm flood conditions with, on average, 69.55 (SD 31.12) per day that both occurred mostly in the morning shifts. Most alarms were issued by the ventilator, invasive blood pressure device, and electrocardiogram (ie, high and low blood pressure, high respiratory rate, low heart rate). The exposure to alarms per bed per day was higher in single rooms (26%, mean 172.9/137.2 alarms per day per bed).ConclusionsAnalyzing ICU alarm log data provides valuable insights into the current alarm situation. Our results call for alarm management interventions that effectively reduce the number of alarms in order to ensure patient safety and ICU staff’s work satisfaction. We hope our DIY instructions encourage others to follow suit in analyzing and publishing their ICU alarm data.

The Role for Health Technology Managers on Fall Prevention Teams

Health technology managers (HTMs) play a pivotal role in ensuring that the devices involved in protecting vulnerable patients from suffering falls are functional and safe for use. Patient falls are common events in healthcare settings, with between 700,000 and 1,000,000 patients suffering falls annually in the United States (Agency for Healthcare Research and Quality. Preventing falls in hospitals. Updated July 2018. https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html). The experience and expertise of HTMs in handling devices throughout their entire lifecycle provide unique perspective and can help to establish proactive measures to ensure the risks of patient falls are mitigated as much as possible. This article will explore, using several real case examples submitted to Food and Drug Administration's MedSun, the many ways that hospitals can best use their HTMs in enhancing their fall prevention teams and overall patient fall mitigation strategies. Among these effective strategies are preadmission risk assessments and education, fostering a no-blame culture of reporting adverse events and device malfunctions, and regular interdisciplinary fall prevention team meetings where best practices can be discussed and implemented.

The Perceived Impact and Usability of a Care Management and Coordination System in Delivering Services to Vulnerable Populations: Mixed Methods Study

BackgroundPeople with complex needs, such as those experiencing homelessness, require concurrent, seamless support from multiple social service agencies. Sonoma County, California has one of the nation’s largest homeless populations among largely suburban communities. To support client-centered care, the county deployed a Care Management and Coordination System (CMCS). This system comprised the Watson Care Manager (WCM), a front-end system, and Connect 360, which is an integrated data hub that aggregates information from various systems into a single client record.ObjectiveThe aim of this study is to evaluate the perceived impact and usability of WCM in delivering services to the homeless population in Sonoma County.MethodsA mixed methods study was conducted to identify ways in which WCM helps to coordinate care. Interviews, observations, and surveys were conducted, and transcripts and field notes were thematically analyzed and directed by a grounded theory approach. Responses to the Technology Acceptance Model survey were analyzed.ResultsA total of 16 participants were interviewed, including WCM users (n=8) and department leadership members (n=8). In total, 3 interdisciplinary team meetings were observed, and 8 WCM users were surveyed. WCM provided a central shared platform where client-related, up-to-date, comprehensive, and reliable information from participating agencies was consolidated. Factors that facilitated WCM use were users’ enthusiasm regarding the tool functionalities, scalability, and agency collaboration. Constraining factors included the suboptimal awareness of care delivery goals and functionality of the system among the community, sensitivities about data sharing and legal requirements, and constrained funding from government and nongovernment organizations. Overall, users found WCM to be a useful tool that was easy to use and helped to enhance performance.ConclusionsWCM supports the delivery of care to individuals with complex needs. Integration of data and information in a CMCS can facilitate coordinated care. Future research should examine WCM and similar CMCSs in diverse populations and settings.

The Role and Activities of Board-Certified Chaplains in Advance Care Planning

Healthcare chaplains have key roles in providing palliative support to patients and families, and they are well-suited to facilitate advance care planning (ACP). However, empirical data on the roles and responsibilities of chaplains in facilitating ACP are limited. To examine the roles of board-certified healthcare chaplains in ACP in various healthcare settings. A cross-sectional, web-based self-report survey was conducted with 585 board-certified chaplains recruited from 3 major professional chaplains' organizations in the U.S. The survey data included chaplains' demographic and professional characteristics, their roles and responsibilities, and responses regarding communication and participation with other healthcare team members in facilitating ACP, including experienced barriers. More participants worked in community hospital settings (42%) and academic medical centers (19.6%) than in any other setting. Over 90% viewed ACP as an important part of their work, 70% helped patients complete advance directives, and 90% helped patients discuss their preferences about end-of-life treatments. Many chaplains were not consistently included in team discussions regarding decision-making, although most chaplains reported that they could always find ways to communicate with their teams. Professional board-certified chaplains regularly engage in facilitating ACP discussions with patients and families in various healthcare settings. There is a need to recognize and provide systematic support for the role of chaplains in facilitating ACP conversations and to integrate chaplains into routine interdisciplinary team and family meetings.

Primary Care-Based Case Conferences and Reductions in Health Care Utilization.

Case conferences are collaborative, interdisciplinary team meetings that facilitate consensus on individual patients' health management plans, coordinate services, and initiate referrals. This approach is well-suited to address the social needs and risks of complex patients. Evidence of this approach in primary care settings to change patient outcomes is limited. A panel of 976 patients from an urban, federally qualified health center were included in case conferences. Fixed-effects regression models estimated the effect of case conferences on admissions, emergency department (ED) visits, and missed outpatient appointments. Case conferencing was associated with a 6% reduction in the probability that the patient would have an ED visit in a given month and a 5% lower probability of an inpatient admission. The probability of missed primary care appointments increased. Case conferences are a potential strategy to address the multiple issues facing complex patients.

Clarifying and Improving the Role of the Psychiatric Consultant

Clarifying and Improving the Role of the Psychiatric Consultant

Implementing an Interdisciplinary Committee to Reduce Psychotropic Drug and Increase Behavioral Intervention Use

In Fiscal Year (FY) 2018, the Butler VA Health Care System’s Psychotropic Medication and Behavior Management Committee was identified as a Veterans Integrated Service Network 4 Best Practice. The goal of this committee is to reduce unnecessary psychotropic medication use and polypharmacy and to increase behavioral intervention implementation among Community Living Center (CLC) Veterans. This committee meets quarterly to review Psychotropic Drug Safety Initiative data, behaviors and behavior care plans, and all psychotropic medications prescribed to Veterans. Psychiatric diagnoses, changes to psychotropic medications, and appropriate behavioral interventions are discussed. Committee members take responsibility for action items in accordance with their discipline; documentation of recommendations are made in quarterly behavioral health assessments in CPRS; and follow-up on action items is completed at twice weekly interdisciplinary treatment team meetings, weekly behavior rounds, and/or as needed. From the first quarter (Q1) of FY16 to Q1 FY20, the Butler VA CLC has seen decreased prescriptions of 2 or more anticholinergics (6.6% to 0.80%), antihistamines (12.5% to 5.9%), benzodiazepines (24.7% to 11.0%), and benzodiazepines or sedative hypnotics (23.2% to 9.0%). While prescription of antipsychotic use has increased (Q1 FY20 = 23.8%), the committee will follow Long Term Care Institute guidelines for gradual dose reductions, behavioral interventions, and as needed psychotropic medication PRN use. This committee provides an interdisciplinary forum to discuss and implement beneficial changes to pharmacological and non-pharmacological interventions among all CLC Veterans. The committee is a valuable process for monitoring and reinforcing best practices that may be easily replicated across VA CLCs nationwide.

ENVISION: A Tool to Improve Communication in Hospice Interdisciplinary Team Meetings.

Hospice interdisciplinary teams (IDTs) are required to meet regularly to update care plans for terminally ill patients and their family caregivers. Although providers see value in these meetings, they also experience frustration over meeting inefficiencies and communication challenges. The current article presents ENVISION, a tool designed to improve communication in hospice IDT meetings by providing attendees with access to up-to-date patient and family data to inform clinical decision making. In the current qualitative descriptive study, researchers explored the perspectives of hospice providers (n = 21) and family caregivers (n = 10) regarding ENVISION's usefulness and ease of use. Numerous factors influenced participants' perceptions of the tool as useful, including its impact on task efficiency, effectiveness, and difficulty. Perceptions of ENVISION's ease of use focused on ease of learning, operating, and interpreting data the tool provided. Findings suggest ENVISION would benefit hospice nurses in care management and senior leadership positions. [Journal of Gerontological Nursing, 46(7), 9-14.].

Pediatric Chronic Critical Illness: Training Teams to Address the Communication Challenges of Patients With Repeated and Prolonged Hospitalizations

ContextChildren with chronic critical illness (CCI) have repeated and prolonged hospitalizations. Discrete communication challenges characterize their inpatient care. ObjectivesDevelop, implement, and evaluate a communication training for inpatient clinicians managing pediatric CCI. MethodsA one-day communication training for interdisciplinary clinicians, incorporating didactic sessions and simulated family and interdisciplinary team meetings. ResultsLearners had an average of 11 years' clinical experience. About 34% lacked prior communication training relevant to pediatric CCI. Mean baseline competence across communication skills was 2.6 (range 2.4–3.2), corresponding to less than somewhat prepared; after the training, this increased to a mean of 4.0 (range 3.5–4.5), corresponding to well prepared. Skills with greatest improvement included conducting a family meeting, delivering bad news, discussing stopping intensive care, and end-of-life communication. After one month, perceived competence was sustained for seven of 10 skills; for remaining skills, perceived competence scores decreased by 0.1–0.2. About 100% of learners would recommend the training to colleagues; 89% advocated it for all clinicians caring for children with CCI. ConclusionInterdisciplinary communication training regarding long stay patients is feasible and valued by novice and seasoned clinicians. The novel integration of intrateam communication skills alongside team-family skills reflects the reality that the care of children with CCI challenges clinicians to communicate well with each other and families. Teaching interdisciplinary teams to share communication skills has the potential to overcome reported limitations of existing inpatient discussions, which can be dominated by one or two physicians and lack contributions from diverse team members.

Dedicated to the Mission: Strategies US Department of Veterans Affairs Home-Based Primary Care Teams Apply to Keep Veterans at Home.

The US Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) Program provides interdisciplinary, long-term primary care for frail, disabled, or chronically ill veterans. This research identifies strategies used by HBPC teams to support veterans in their homes, rather than in institutionalized care. Focus groups and semistructured interviews were conducted with HBPC interdisciplinary team (IDT) members, including program directors, medical directors, and key staff, from September 2017 to March 2018. Field observations were gathered during visits to veterans' homes and IDT meetings. In-person site visits were conducted at eight HBPC Programs across the United States. Sites varied in location, setting, and primary care model. A total of 105 HBPC professionals. Qualitative thematic content analysis. Four main strategies drive and support the shared mission of IDTs to support veterans at home: fostering frequent communication among IDT members, veterans, caregivers, and outside agencies; development of longitudinal, trusting, reliable relationships within IDTs and with veterans and caregivers; ongoing, consistent education for IDT members and veterans and caregivers; and collaboration within and outside IDTs. Adhering to this mission meant providing timely and efficient care that kept veterans in their homes and minimized the need for acute hospitalizations and nursing home placement. HBPC IDTs studied worked together across disciplines to effectively create a dedicated culture of caring for veterans, caregivers, and themselves, leading to keeping veterans at home. Focusing on the strategies identified in this research may be useful to achieve similar positive outcomes when caring for medically complex, homebound patients within and outside the VA. J Am Geriatr Soc 67:2511-2518, 2019.

Success of a Nurse Practitioner–led Interdisciplinary Team

The nurse practitioner–led interdisciplinary team (IDT) was established to reduce readmissions by optimizing care for a select group of high-risk patients. Two new standards of care were established: weekly IDT meetings leading to implementation of a shared care plan and standard workflows for posthospital visits. The new standard of care resulted in a median readmission rate reduction from 28% (10%-32%) to 9% (4%-12%). The nurse practitioner–led IDT reduced the median readmission rate by 64%.

ACE Model for Older Adults in ED.

The emergency department (ED) is uniquely positioned to improve care for older adults and affect patient outcome trajectories. The Mount Sinai Hospital ED cares for 15,000+ patients >65 years old annually. From 2012 to 2015, emergency care in a dedicated Geriatric Emergency Department (GED) replicated an Acute Care for Elderly (ACE) model, with focused assessments on common geriatric syndromes and daily comprehensive interdisciplinary team (IDT) meetings for high-risk patients. The IDT, comprised of an emergency physician, geriatrician, transitional care nurse (TCN) or geriatric nurse practitioner (NP), ED nurse, social worker (SW), pharmacist (RX), and physical therapist (PT), developed comprehensive care plans for vulnerable older adults at high risk for morbidity, ED revisit, functional decline, or potentially avoidable hospital admission. Patients were identified using the Identification of Seniors at Risk (ISAR) screen, followed by geriatric assessments to assist in the evaluation of elders in the ED. On average, 38 patients per day were evaluated by the IDT with approximately 30% of these patients formally discussed during IDT rounds. Input from the IDT about functional and cognitive, psychosocial, home safety, and pharmacological assessments influenced decisions on hospital admission, care transitions, access to community based resources, and medication management. This paper describes the role of a Geriatric Emergency Medicine interdisciplinary team as an innovative ACE model of care for older adults who present to the ED.

Frequency and Characteristics of Recommendations from Interdisciplinary Outpatient Cancer Rehabilitation Monthly Team Meetings.

Ambulatory cancer rehabilitation programs vary widely in the types of services offered, and there is a lack of consistency with respect to the coordination of rehabilitation with oncologic treatment plans. There are no guidelines for outpatient interdisciplinary rehabilitation team meetings, and the types and characteristics of recommendations that a physiatrist can provide during these meetings have not been reported. To identify the frequency and characteristics of different types of recommendations that were derived through monthly interdisciplinary outpatient rehabilitation team meetings involving physiatrists, physical therapists, and occupational therapists. Case series-descriptive study. Quaternary cancer center. Outpatient rehabilitation cancer patients discussed during consecutive monthly team meetings. Frequency and characteristics of recommendations. Over a 7-month period, there were 57 potential patients to be discussed, and 42 patients were discussed. Among the 42 patients, 30 received recommendations, which yields 71% of patients receiving at least 1 recommendation. Some patients required repeated discussions in different months; thus, a total of 71 discussions occurred and resulted in 51 recommendations. Out of the 71 discussions, 41 (58%) discussions resulted in recommendations such as coordination of care in 19 (37%) cases, physiatry clinic follow-up in 9 cases (18%), oncology clinic follow-up in 7 cases (14%), and orders for referrals to other health professionals were placed in 5 cases (10%). Thirty discussions (42%) did not result in any recommendations, with the most common reason being stable or having improved functional status. In contrast to acute inpatient rehabilitation interdisciplinary weekly team meetings required by Centers for Medicare and Medicaid Services, there are no guidelines for outpatient interdisciplinary rehabilitation team meetings. Thus, the types and characteristics of recommendations that a physiatrist can provide during these meetings have not been previously reported. Regularly scheduled outpatient interdisciplinary cancer rehabilitation team meetings increase communication among rehabilitation specialists to identify outpatients experiencing barriers to therapy progress, provide recommendations to address those barriers, and reassess rehabilitation goals previously established. IV.

Development of an integrated palliative and supportive care service within an academic cancer center.

99 Background: Timely incorporation of palliative services with chemotherapy treatment has become a new standard of care for oncology patients based on evidence-driven national clinical practice guidelines. However, best practices for service integration are not known, particularly for small academic centers. In our 224 bed university hospital, we hypothesized that advertisement, responsiveness to needs and service integration would result in increased utilization of palliative and supportive care. We report the process of developing our Integrated Model of Care. Methods: The program began with a 1.0 FTE APRN boarded as a FNP and certified as an advanced hospice and palliative nurse. The goal was to identify opportunities for her integration within the outpatient cancer center. A needs-assessment survey was sent to medical oncology faculty with the following items: proposed change in service name, care areas of greatest need, limitations to providing palliative care, additional growth opportunities. The Interdisciplinary Supportive Care Team was created utilizing existing staff. One year of billed consults were reviewed. The APRN attended tumor boards, team meetings, biweekly Interdisciplinary Team Meetings, communicated directly with the Inpatient Hem/Onc Team and provided educational sessions. Results: Needs assessment survey and service name change proposal sent to 14 oncology providers: 50% completed survey; seven responded YES to name change; zero providers responded NO. Of the 489 consults billed within the 1st year of service, 249 were inpatient and 240 outpatients. 168 individual patients were referred; > 72 patients were referred to palliative/hospice services; > 82 patients died. One year satisfaction survey; 17 respondents; 88.23% were satisficed and 100% would consult again. Conclusions: Medical oncology faculty at our institution responded favorably to the development of a designated “Oncology Supportive Care Service” evidenced by increased consultation and utilization of services. Optimizing clinical infrastructure, processes, education and research has led to the success of this integrated care model, lending to recruitment of additional allied health professionals and ongoing program growth.

A Statewide Elder Mistreatment Virtual Assessment Program: Preliminary Data.

To describe the Texas Elder Abuse and Mistreatment Institute Forensic Assessment Center Network (TEAM-FACN), a novel statewide elder mistreatment (EM) virtual assessment program using low-cost videophone technology and innovative web-based coordination to connect an Adult Protective Services (APS) agency and its clients, rural and urban, to a centralized geriatric and EM expert medical team for virtual in-home assessments. Descriptive. Community. APS clients aged 18 and older. Virtual and in-home assessments. Program use and type of services provided. In the first 8 months, 300 APS clients from all regions of the state were referred for assessment. Outcomes realized include a quadrupling in number of client assessments. TEAM-FACN physicians provided an average of 2 services, which included 216 mental health assessments, with 123 conducted virtually; 42 medical assessments; 45 guardianship filings; 5 employee misconduct registry reviews; and more than 230 interdisciplinary team meetings to discuss case findings, safety plans, and medical and social interventions. TEAM-FACN provides an innovative and viable way to increase access of urban and rural older and adults who are being mistreated to expert geriatric and EM protective service assessments. J Am Geriatr Soc 67:151-155, 2019.

Frequency and characteristics of interventions from interdisciplinary outpatient cancer rehabilitation monthly team meetings

Ambulatory cancer rehabilitation programs vary widely in the types of services offered, and there is a lack of consistency with respect to the coordination of rehabilitation with oncologic treatment plans. There are no guidelines for outpatient interdisciplinary rehabilitation team meetings, and the types and characteristics of interventions that a physiatrist can provide during these meetings have not been reported. The aims are as follows: –identify the frequency and characteristics of interventions derived through monthly interdisciplinary outpatient cancer rehabilitation team meetings involving physiatrists, physical therapists, and occupational therapists; –compare the clinical characteristics of patients who did and did not receive interventions. This is a retrospective study of consecutive monthly outpatient interdisciplinary rehabilitation team meetings with physiatrists’ participation. Over a 7-month period, there were 57 potential patients to be discussed and 42 patients were discussed. Among the 42 patients, 12 of them did not receive any interventions and 30 did, which yields 71% of patient receiving at least one intervention. Some patients required repeated discussions in different months; thus, a total of 71 discussions occurred and resulted in 51 interventions. Of the 71 discussions, 41 (58%) resulted in interventions and the most common intervention was coordination of care (37%). Thirty discussions (42%) did not result in any interventions, with the most common reason being stable or having improved functional status. Regularly scheduled outpatient interdisciplinary cancer rehabilitation team meetings increase communication among rehabilitation specialists to identify outpatients experiencing barriers to therapy progress, provide interventions to address those barriers, and reassess rehabilitation goals previously established.

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

This manuscript describes a streamlined protocol for the management of patients with acute ischemic stroke, which aims at the minimization of time from hospital admission to reperfusion. Rapid restoration of cerebral blood flow is essential for the outcomes of patients with acute ischemic stroke. Endovascular treatment (EVT) has become the standard of care to accomplish this in patients with acute stroke due to large vessel occlusion (LVO). To achieve reperfusion of ischemic brain regions as fast as possible, all in-hospital time delays have to be carefully avoided. Therefore, management of patients with acute ischemic stroke was optimized with an interdisciplinary standard operating procedure (SOP). Stroke neurologists, diagnostic as well as interventional neuroradiologists, and anesthesiologists streamlined all necessary processes from patient admission and diagnosis to EVT of eligible patients. Target times for every step were established. Actually achieved times were prospectively recorded along with clinical data and imaging scores for all endovascularly treated stroke patients. These data were regularly analyzed and discussed in interdisciplinary team meetings. Potential issues were evaluated and all staff involved was trained to adhere to the SOP. This streamlined patient management approach and enhanced interdisciplinary collaboration reduced time from patient admission to reperfusion significantly and was accompanied by a beneficial effect on clinical outcomes.

Optimized Management of Endovascular Treatment for Acute Ischemic Stroke.

This manuscript describes a streamlined protocol for the management of patients with acute ischemic stroke, which aims at the minimization of time from hospital admission to reperfusion. Rapid restoration of cerebral blood flow is essential for the outcomes of patients with acute ischemic stroke. Endovascular treatment (EVT) has become the standard of care to accomplish this in patients with acute stroke due to large vessel occlusion (LVO). To achieve reperfusion of ischemic brain regions as fast as possible, all in-hospital time delays have to be carefully avoided. Therefore, management of patients with acute ischemic stroke was optimized with an interdisciplinary standard operating procedure (SOP). Stroke neurologists, diagnostic as well as interventional neuroradiologists, and anesthesiologists streamlined all necessary processes from patient admission and diagnosis to EVT of eligible patients. Target times for every step were established. Actually achieved times were prospectively recorded along with clinical data and imaging scores for all endovascularly treated stroke patients. These data were regularly analyzed and discussed in interdisciplinary team meetings. Potential issues were evaluated and all staff involved was trained to adhere to the SOP. This streamlined patient management approach and enhanced interdisciplinary collaboration reduced time from patient admission to reperfusion significantly and was accompanied by a beneficial effect on clinical outcomes.

Acute care medical interventions in the palliative care unit versus inpatient hospice.

88 Background: In a survey of different cancer centers in the United States, only 23% reported having dedicated palliative care beds and hospital executives have reported not having further plans for expansion of their program. Barriers that are often cited include poor reimbursement for services, limited institutional support and resources. Patients admitted to an Acute Palliative care unit (APCU) benefit from the multidisciplinary approach that is evident in daily rounds, interdisciplinary team meetings, and family conferences. There could be occasionally misconceptions about the differences between inpatient hospice and an APCU. Even though the psychosocial component of palliative care is extremely important a significant amount of medical interventions also are necessary to provide patients and family with a sense of and optimal care during this time. Methods: A retrospective chart reviewed was performed in 100 consecutives patients admitted to the APCU and inpatient hospice prior to October 2013. From this data we identified the acute medical interventions ordered by the palliative Care specialist tduring the first 5 days of admission. Results: A total of 100 patients from the APCU and 100 patients from inpatient hospice were reviewed. In the APCU 100% of patients had iv fluids vs 7% in inpatient hospice. Antibiotics were given in 52% of APCU patients vs 2% in the inpatient hospice. Steroids were given in 48% of APCU patients vs 30% in inpatient hospices. (See Table). Conclusions: The APCU in comparison to inpatient hospices had higher rate of acute medical interventions with the most common been iv fluids, antibiotics, laboratory and radiologic diagnostic tests. This represent the importance of Acute Palliative Care Units in advanced cancer patients with complicated situations to achieve comfort when transitioning to EOL. [Table: see text]