0
Education, Teaching, and Quality Improvement |

A Quality Improvement Survey Assessment of Resident Physician Management With End of Life Care

Arpan Patel, MD; Joan Mitchell, MD; Changwan Ryu, MD
Author and Funding Information

SUNY Upstate Medical University/Syracuse VA Medical Center, Syracuse, NY


Chest. 2013;144(4_MeetingAbstracts):533A. doi:10.1378/chest.1705191
Text Size: A A A
Published online

Abstract

SESSION TITLE: Clinical Improvement Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Our aim was to evaluate resident physician management with end of life. Through a survey assessment, we identified areas of need for quality improvement in our medical education and hospital systems.

METHODS: We surveyed residents in an internal medicine training program. We developed a 7-item questionnaire, adapted from published studies to assess end of life care regarding clinical skills and hospital systems. To evaluate clinical knowledge, we asked residents to self-report on a 1-5 scale, with 1 being poor and 5 being excellent, how well they perform in (1) discussing end of life care with patients and their families, (2) managing pain, and (3) managing symptoms other than pain. From a systems standpoint, we asked residents on a 1-5 scale, with 1 being completely disagree and 5 being completely agree, with the availability of (1) consultants, (2) documentation of palliative care needs, and (3) palliative care orders. We collected 54 surveys (18 surveys per resident class) and conducted single factor ANOVA analysis with post-hoc Bonferroni correction to compare responses.

RESULTS: The intern class had statistically significant lower responses (t-test p<0.001). Within the intern class, there were statistically significant differences in scores regarding initiating an end of life discussion (t-test p=0.004), pain management (t-test p=0.005) and managing symptoms other than pain (t-test p=0.004). For our hospital processes, there were statistically significant differences reported among the second year and third year classes regarding the availability of consult services (t-test p=0.001) and appropriate palliative care orders (t-test p=0.007).

CONCLUSIONS: Interns reported significant difficulty in several areas of end of life care as expected. Senior residents displayed more confidence in their management skills but reported significantly lower scores for hospital systems. This is likely because as they cared for more terminally ill patients, they encountered more systems issues that hindered management.

CLINICAL IMPLICATIONS: Our findings identified areas of need for improvement in our medical education and hospital systems. We plan to expand our medical education curriculum to include simulated end of life patient encounters and didactic sessions on effective end of life management. For a process improvement plan, we created a clinical pathway that centralizes all available palliative care documents, consultants, and clinical care orders to facilitate end of life management.

DISCLOSURE: The following authors have nothing to disclose: Arpan Patel, Joan Mitchell, Changwan Ryu

No Product/Research Disclosure Information


Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543