0
Education, Teaching, and Quality Improvement |

Early Family Meetings in the MICU for Older Adults With Multisystem Organ Failure: A Quality Improvement Initiative

Sagar Patel; Sunena Tewani, MD; Nicholas Bosch, MD; Julian Mesa, MD; Michael Ieong, MD; Renda Wiener, MPH
Author and Funding Information

Boston University School of Medicine, Boston, MA


Chest. 2014;146(4_MeetingAbstracts):522A. doi:10.1378/chest.1965624
Text Size: A A A
Published online

Abstract

SESSION TITLE: Quality & Clinical Improvement (Poster Discussion)

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Guidelines suggest early family meetings to establish goals of care at the end of life for critically ill patients with an anticipated poor prognosis. The goal of the project was to assess the effect of a quality improvement (QI) initiative at a single urban medical center instituting early family meetings (within 4 days of MICU admission) for older adults with multi-system organ failure.

METHODS: ​A QI intervention was conducted between February-May 2012. The intervention consisted of two presentations to MICU staff explaining the rationale and desired content of early family meetings, introduction of a structured family meeting template into the electronic medical record, and regular reminders to MICU staff and residents about the intervention. For this study, the primary population included MICU patients over age 80 with 2 or more organ failures. Retrospective chart review was performed to compare proportion of early family meetings among MICU patients in the pre- (August 2011-January 2012) versus post-intervention (June-December 2012) cohorts. Of note, this study was part of a multi-component QI initiative to increase early family meetings in populations with anticipated poor prognosis; other triggers included patients with metastatic cancer and those status post cardiac arrest.

RESULTS: The pre- (n=63) and post-intervention (n=54) groups were similar with regard to demographics (age, sex, race). There was no significant difference in the proportion of early family meetings for patients over the age of 80 with two or more organ failures in the pre- vs. post-intervention cohorts (38.1% vs 37.0%, p=0.85). By contrast, the other populations in this QI initiative achieved significant increases in the proportion of early family meetings (metastatic cancer: 27 vs 61%, p=0.01; cardiac arrest: 36.5% vs 63.5%, p=0.001).

CONCLUSIONS: Our QI initiative did not achieve our primary outcome of increased proportion of early family meetings among patients aged 80 or over with 2 or more organ failures. While the other triggers in this QI initiative (metastatic cancer; cardiac arrest) were clear-cut, there was greater variability in disease severity and likely perceived prognosis of patients over age 80 with 2 or more organ failures. Such variabilty may have led to lack of buy-in for this trigger among MICU staff, resulting in a failure to adhere to the QI initiative.

CLINICAL IMPLICATIONS: For QI initiatives to be successful, there must be consensus among staff about the importance and appropriateness of the trigger.

DISCLOSURE: The following authors have nothing to disclose: Sagar Patel, Sunena Tewani, Nicholas Bosch, Julian Mesa, Michael Ieong, Renda Wiener

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