Palliative Care: Rapid Redesign to Support Systemwide Quality Improvement

Objectives: We conducted a pilot quality improvement (QI) project with the aim of improving accessibility of palliative care to critically ill neurosurgical patients. Methods: The QI project was conducted in the neurosurgical intensive care unit (NS-ICU). Prior to the QI project, referral rates to palliative care were low. The ICU-Palliative Care collaborative comprising of the palliative and intensive care team led the QI project from 2013 to 2015. The interventions included engaging key stake-holders, establishing formal screening and referral criteria, standardizing workflows and having combined meetings with interdisciplinary teams in ICU to discuss patients’ care plans. The Palliative care team would review patients for symptom optimization, attend joint family conferences with the ICU team and support patients and families post-ICU care. We also collected data in the post-QI period from 2016 to 2018 to review the sustainability of the interventions. Results: Interventions from our QI project and the ICU-Palliative Care collaborative resulted in a significant increase in the number of referrals from 9 in 2012 to 44 in 2014 and 47 the year later. The collaboration was beneficial in facilitating transfers out of ICU with more deaths outside ICU on comfort-directed care (96%) than patients not referred (75.7%, p < 0.05). Significantly more patients had a Do-Not-Resuscitation (DNR) order upon transfer out of ICU (89.7%) compared to patients not referred (74.2.%, p < 0.001), and had fewer investigations in the last 48 hours of life (p < 0.001). Per-day ICU cost was decreased for referred patients (p < 0.05). Conclusions: Multi-faceted QI interventions increased referral rates to palliative care. Referred patients had fewer investigations at the end-of-life and per-day ICU costs.

Download Full-text

Integration of Early Palliative Care in Oncology Patients: Improving Nursing Knowledge and Confidence

10.28971/532019hj118 ◽

2019 ◽

Author(s):

Jacqueline Hurteau

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Nursing Education ◽

Program Development ◽

Quality Improvement Project ◽

Improvement Project ◽

Early Palliative Care ◽

Early Implementation ◽

Oncology Care ◽

Nurses Knowledge

Palliative care integrated with standard oncology care in cancer patients has been shown to provide a number of beneficial clinical outcomes. Despite the evidence, the utilization of palliative care in the oncology population continues to be inadequate. The purpose of this program development, quality improvement project was to improve nurses’ knowledge regarding palliative care and the benefits of its early implementation in the oncology population, as well as to improve their confidence regarding palliative care consultations to providers. An educational intervention was designed and a pre and posttest were utilized to determine the effect of the intervention. This program development, quality improvement project demonstrated that the implementation of nursing education regarding palliative care within the oncology population increased nurses’ knowledge in palliative care, specific to the oncology population, as well as confidence in recommending appropriate palliative care consultations to providers.

Download Full-text

Together We Can Go Farther: Using Palliative Care Collaboratives to Drive Quality Improvement (TH304)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2015.12.130 ◽

2016 ◽

Vol 51 (2) ◽

pp. 317

Author(s):

Ashley Bragg ◽

Kara Bischoff ◽

Steven Pantilat ◽

Arif Kamal ◽

Katherine Ast

Keyword(s):

Palliative Care ◽

Quality Improvement

Download Full-text

Quality Improvement Initiatives to Reduce Mortality: An Opportunity to Engage Palliative Care and Improve Advance Care Planning

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118794149 ◽

2018 ◽

Vol 36 (2) ◽

pp. 97-104 ◽

Cited By ~ 3

Author(s):

Signe Peterson Flieger ◽

Erica Spatz ◽

Emily J. Cherlin ◽

Leslie A. Curry

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

End Of Life ◽

Advance Care Planning ◽

Secondary Analysis ◽

Care Quality ◽

Care Planning ◽

Goals Of Care ◽

Patient Goals ◽

Advance Care

Background: Despite substantial efforts to integrate palliative care and improve advance care planning, both are underutilized. Quality improvement initiatives focused on reducing mortality may offer an opportunity for facilitating engagement with palliative care and advance care planning. Objective: In the context of an initiative to reduce acute myocardial infarction (AMI) mortality, we examined challenges and opportunities for engaging palliative care and improving advance care planning. Methods: We performed a secondary analysis of qualitative data collected through the Leadership Saves Lives initiative between 2014 and 2016. Data included in-depth interviews with hospital executives, clinicians, administrators, and quality improvement staff (n = 28) from 5 hospitals participating in the Mayo Clinic Care Network. Focused analysis examined emergent themes related to end-of-life experiences, including palliative care and advance care planning. Results: Participants described challenges related to palliative care and advance care planning in the AMI context, including intervention decisions during an acute event, delivering care aligned with patient and family preferences, and the culture around palliative care and hospice. Participants proposed strategies for addressing such challenges in the context of improving AMI quality outcomes. Conclusions: Clinicians who participated in an initiative to reduce AMI mortality highlighted the challenges associated with decision-making regarding interventions, systems for documenting patient goals of care, and broader engagement with palliative care. Quality improvement initiatives focused on mortality may offer a meaningful and feasible opportunity for engaging palliative care. Primary palliative care training is needed to improve discussions about patient and family goals of care near the end of life.

Download Full-text

Cross-Content Area Questions and Answers

Mayo Clinic Internal Medicine Board Review Questions and Answers ◽

10.1093/med/9780199985876.003.0015 ◽

2013 ◽

pp. 123-140

Author(s):

Robert D. Ficalora

Keyword(s):

Internal Medicine ◽

Palliative Care ◽

Quality Improvement ◽

Preventive Medicine ◽

Content Area ◽

Content Areas ◽

General Internal ◽

Questions And Answers ◽

Medicine Quality ◽

Board Review

Chapter 15 presents multiple-choice, board review questions on cross-content areas including geriatrics, preventive medicine, women’s health, general internal medicine, quality improvement, medical ethics, palliative care, and perioperative medicine. Full explanations are provided with the correct answers.

Download Full-text

Improving the waiting times within a hospice breathlessness service

BMJ Open Quality ◽

10.1136/bmjoq-2018-000582 ◽

2019 ◽

Vol 8 (2) ◽

pp. e000582

Author(s):

Caroline Sime ◽

Stuart Milligan ◽

Kevin Donal Rooney

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Waiting Time ◽

Current System ◽

Waiting Times ◽

Well Being ◽

Common Symptom ◽

Specialist Palliative Care ◽

Published Evidence

BackgroundBreathlessness, a common symptom in advanced disease, is a distressing, complex symptom that can profoundly affect the quality of one’s life. Evidence suggests that specialist palliative care breathlessness intervention services can improve physical well-being, personal coping strategies and quality of life. In the UK, the use of quality improvement methods is well documented in the National Health Service. However, within the independent hospice sector there is a lack of published evidence of using such methods to improve service provision.AimThe aim of this project was to reduce the waiting time from referral to service commencement for a hospice breathlessness service by 40%—from a median of 19.5 to 11.5 working days.MethodsUsing a quality planning and systems thinking approach staff identified barriers and blockages in the current system and undertook plan-do-study-act cycles to test change ideas. The ideas tested included offering home visits to patients on long-term oxygen, using weekly team ‘huddles’, streamlining the internal referral process and reallocating staff resources.ResultsUsing quality improvement methods enabled staff to proactively engage in positive changes to improve the service provided to people living with chronic breathlessness. Offering alternatives to morning appointments; using staff time more efficiently and introducing accurate data collection enabled staff to monitor waiting times in real time. The reduction achieved in the median waiting time from referral to service commencement exceeded the project aim.ConclusionsThis project demonstrates that quality improvement methodologies can be successfully used in a hospice setting to improve waiting times and meet the specific needs of people receiving specialist palliative care.

Download Full-text