Assessing Emotional Suffering in Palliative Care: Use of a Structured Note Template to Improve Documentation

Lamba, Sangeeta; Berlin, Ana; Goett, Rebecca; Ponce, Christopher B.; Holland, Bart; Walther, Susanne; Aslakson, Rebecca; Ast, Katherine; Elk, Ronit; Garner, Kimberly K.; Gramling, Robert; Grudzen, Corita; Kamal, Arif H.; LeBlanc, Thomas W.; Rhodes, Ramona L.; Roeland, Eric; Unroe, Kathleen T.

doi:10.1016/j.jpainsymman.2016.01.017

Cited by 14 publications

(5 citation statements)

References 9 publications

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“…Several studies have shown that a template can improve capture of data in documentation which improves qualities of documentation. 13,14 This QI project continues the theme that a template improves the quality of key components of documentation in family meetings within a critical care unit. 15 There may be additional education about key elements in a family meeting when physicians use the pro forma record.…”

Section: Discussionmentioning

confidence: 96%

Improving the quality of family meeting documentation in the ICU at the end of life

et al. 2022

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Objective: Improve documentation quality of end-of-life family meetings in a tertiary intensive care unit (ICU). Design: Before-and-after interventional quality improvement project between October 2018 and February 2020 utilising an electronic pro-forma record. Setting: Australian, University affiliated, mixed medical-surgical 22 bed adult ICU. Participants: Patients who were admitted to the ICU for active management and subsequently died during that ICU admission. We enrolled 50 patients who died before and 50 patients after the introduction of the electronic family meeting pro-forma record. Intervention: Through collaboration with ICU medical and nursing staff, End-of-life Special Interest Group and Clinical Documentation Committee we developed the ICU Family Meeting Discussion Note as an electronic pro-forma record with multiple key fields of entry. Main outcome measures: Patient records were examined for the presence of documented details around patient’s admission, family meetings and specific elements surrounding the patient’s death. Results: The introduction of a pro-forma record markedly improved the quality of documentation of end-of-life care related family meetings. Documentation increased in recording hospital admission date/time (6% vs 84%), meeting location (14% vs 70%), the reason patients were absent from the meeting (34% vs 72%), the Medical Treatment Decision Maker (MTDM) (10% vs 44%), the patient’s resuscitation status (22% vs 54%), and treatment options discussed (78% vs 94%) ( p ⩽ 0.005 for all). Conclusion: Introducing an electronic pro-forma record to facilitate family meeting documentation increased the frequency of important recorded information. Further studies are required to assess whether documentation quality improvements are sustainable and whether they affect patient- or relative-centred outcomes.

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Section: Discussionmentioning

confidence: 96%

Improving the quality of family meeting documentation in the ICU at the end of life

et al. 2022

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“…Aggregative dashboards are but one of many tools for reducing EHR workload. Such solutions include note templates, such as that provided by Epic SmartPhrases (Epic Systems Corporation, Verona, Wisconsin, Unites States), 30,31 strategic menu design, 32,33 and order sets. 34 Automationcentric innovations also exist, such as automated problem list generation 35 and follow-up determination after radiographic testing, 36 as well as clinical decision support, alerts for risk stratification 37 and drug-disease interactions.…”

Section: Discussionmentioning

confidence: 99%

Neurological Dashboards and Consultation Turnaround Time at an Academic Medical Center

et al. 2019

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Background Neurologists perform a significant amount of consultative work. Aggregative electronic health record (EHR) dashboards may help to reduce consultation turnaround time (TAT) which may reflect time spent interfacing with the EHR. Objectives This study was aimed to measure the difference in TAT before and after the implementation of a neurological dashboard. Methods We retrospectively studied a neurological dashboard in a read-only, web-based, clinical data review platform at an academic medical center that was separate from our institutional EHR. Using our EHR, we identified all distinct initial neurological consultations at our institution that were completed in the 5 months before, 5 months after, and 12 months after the dashboard go-live in December 2017. Using log data, we determined total dashboard users, unique page hits, patient-chart accesses, and user departments at 5 months after go-live. We calculated TAT as the difference in time between the placement of the consultation order and completion of the consultation note in the EHR. Results By April 30th in 2018, we identified 269 unique users, 684 dashboard page hits (median hits/user 1.0, interquartile range [IQR] = 1.0), and 510 unique patient-chart accesses. In 5 months before the go-live, 1,434 neurology consultations were completed with a median TAT of 2.0 hours (IQR = 2.5) which was significantly longer than during 5 months after the go-live, with 1,672 neurology consultations completed with a median TAT of 1.8 hours (IQR = 2.2; p = 0.001). Over the following 7 months, 2,160 consultations were completed and median TAT remained unchanged at 1.8 hours (IQR = 2.5). Conclusion At a large academic institution, we found a significant decrease in inpatient consult TAT 5 and 12 months after the implementation of a neurological dashboard. Further study is necessary to investigate the cognitive and operational effects of aggregative dashboards in neurology and to optimize their use.

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“…12 In fact, previous work has linked use of EMR in hospice with greater attention to key quality of care domains. 28,29 Additionally, structured and well-designed assessments yield more objective data and can be quicker to complete. We also believe it is essential that developers of hospice social work assessmentsdwhether electronic or paper-baseddshould obtain input from experienced social workers with knowledge of the unique complexities of the hospice setting.…”

Section: Discussionmentioning

confidence: 99%

Psychosocial Assessment by Hospice Social Workers: A Content Review of Instruments From a National Sample

Cagle

Osteen

Sacco

et al. 2017

Journal of Pain and Symptom Management

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Assessing Emotional Suffering in Palliative Care: Use of a Structured Note Template to Improve Documentation

Cited by 14 publications

References 9 publications

Improving the quality of family meeting documentation in the ICU at the end of life

Improving the quality of family meeting documentation in the ICU at the end of life

Neurological Dashboards and Consultation Turnaround Time at an Academic Medical Center

Psychosocial Assessment by Hospice Social Workers: A Content Review of Instruments From a National Sample

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