Improved Physician Understanding of Patient End-of-Life Preferences: A Quality Improvement Project

Authors

Kristin Stawiarski, Section of Cardiovascular Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT. Electronic address: kristin.stawiarski@bpthosp.org.Follow
Gini Priyadharshini Jeyashanmugaraja, Section of Cardiovascular Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT.
Kristin Edwards, Section of Geriatrics and Palliative Care, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT.
Gloria Bindelglass, Section of Cardiovascular Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT.Follow
Gilead Lancaster, Section of Cardiovascular Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT.Follow

Document Type

Article

Publication Title

Journal of pain and symptom management

Abstract

BACKGROUND: Code status (CS) orders lack a universal definition. We aimed to improve provider understanding of order options. MEASURES: Provider's knowledge of CS terminology, ease of understanding CS orders and ease of starting CS discussions. INTERVENTION: A multifaceted intervention including 1) altered CS order language in the electronic medical record (EMR) from "Full Interventions," "Limited Interventions," and "Comfort Measures Only" to "Full advanced cardiovascular life support (ACLS)," "Partial ACLS," and "No ACLS" 2) clinical tools for CS identification 3) provider education. OUTCOMES: Correct provider response rate for "Partial ACLS" and "No ACLS" terms increased from 43.5 to 60% and 20 to 71% (odds ratio 1.95; 95% confidence interval 0.99-3.83; P = 0.03, OR 9.8; CI 4.48-21.49; P < 0.001). The proportion of providers who felt understanding CS orders and starting conversations about CS was "very easy" (a score of 1-3 on a scale of 1 to 10) improved from 26.1 to 45.7% (P = 0.01) and 49.3 to 65.7% (P = 0.03). CONCLUSIONS/LESSONS LEARNED: Provider understanding of CS options can be improved with a combined QI intervention.

First Page

1289

Last Page

1294

DOI

10.1016/j.jpainsymman.2021.05.023

Publication Date

12-1-2021

Recommended Citation

Stawiarski, Kristin; Priyadharshini Jeyashanmugaraja, Gini; Edwards, Kristin; Bindelglass, Gloria; and Lancaster, Gilead, "Improved Physician Understanding of Patient End-of-Life Preferences: A Quality Improvement Project" (2021). Cardiology. 77.
https://scholar.bridgeporthospital.org/cardiology/77

Identifier

34118369 (pubmed); 10.1016/j.jpainsymman.2021.05.023 (doi); S0885-3924(21)00377-8 (pii)