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