Implementation of the Serious Illness Care Program on Hospital Medical Wards

Singh, Japteg; Simon, Jessica; Ma, Irene; Dunne, Fiona; Dugan, Alison; Wooller, Krista; Munene, Peter; Kobewka, Daniel; Jayaraman, Dev; Swinton, Marilyn; Lagrotteria, Andrew; Bernacki, Rachelle; You, John J.

doi:10.22374/cjgim.v16i3.484

Cited by 4 publications

(7 citation statements)

References 26 publications

(38 reference statements)

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“…There has recently been a groundswell of interest in goals of care conversations. Research has sought to identify where and when they occur, 21,22 why they are frequently not done, 23 and how education can improve provider comfort with them 24,25 . What is less well studied is the structure or content of these conversations, and how this can influence decision‐making.…”

Section: Discussionmentioning

confidence: 99%

Recommendation‐making in the emergency department: A qualitative study of how Canadian emergency physicians guide treatment decisions about resuscitation in critically ill patients

2023

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Section: Discussionmentioning

confidence: 99%

Recommendation‐making in the emergency department: A qualitative study of how Canadian emergency physicians guide treatment decisions about resuscitation in critically ill patients

2023

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“…1 Achieving a healthcare system that values and prioritizes patient-centeredness requires that hospital-based clinicians have tools, training and resources to identify patients with elevated mortality risk, conduct these conversations and document these conversations so they can readily be carried forward in the medical record. 1 Initiatives to improve rates of SICs [35][36][37] or ACP 38,39 in the inpatient setting have found higher rates of SIC or ACP completion and improved patient and caregiver satisfaction. 37,38 Clinicians also agree that SICs enhance clinical care and can be provided in an appropriate amount of time.…”

Section: Discussionmentioning

confidence: 99%

The Association of Standardized Documentation of Serious Illness Conversations With Healthcare Utilization in Hospitalized Patients: A Propensity Score Matched Cohort Analysis

Serna

Yoon

Fiskio

et al. 2023

Am J Hosp Palliat Care

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Background: Serious Illness Conversations (SICs) conducted during hospitalization can lead to meaningful patient participation in the decision-making process affecting medical management. The aim of this study is to determine if standardized documentation of a SIC within an institutionally approved EHR module during hospitalization is associated with palliative care consultation, change in code status, hospice enrollment prior to discharge, and 90-day readmissions. Methods: We conducted retrospective analyses of hospital encounters of general medicine patients at a community teaching hospital affiliated with an academic medical center from October 2018 to August 2019. Encounters with standardized documentation of a SIC were identified and matched by propensity score to control encounters without a SIC in a ratio of 1:3. We used multivariable, paired logistic regression and Cox proportional-hazards modeling to assess key outcomes. Results: Of 6853 encounters (5143 patients), 59 (.86%) encounters (59 patients) had standardized documentation of a SIC, and 58 (.85%) were matched to 167 control encounters (167 patients). Encounters with standardized documentation of a SIC had greater odds of palliative care consultation (odds ratio [OR] 60.10, 95% confidence interval [CI] 12.45-290.08, P < .01), a documented code status change (OR 8.04, 95% CI 1.54-42.05, P = .01), and discharge with hospice services (OR 35.07, 95% CI 5.80-212.08, P < .01) compared to matched controls. There was no significant association with 90-day readmissions (adjusted hazard ratio [HR] .88, standard error [SE] .37, P = .73). Conclusions: Standardized documentation of a SIC during hospitalization is associated with palliative care consultation, change in code status, and hospice enrollment.

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“…To assess change in responses to the "feeling heard and understood" question before and after a serious illness conversation, we used a paired t-test, as defined a priori, assigning the following values to the response options (1 = not at all, 2 = slightly, 3 = moderately, 4 = quite a bit, 5 = completely). 9 We used counts and proportions to describe the distribution of responses to the questions on the patient and clinician experience questionnaires.…”

Section: Discussionmentioning

confidence: 99%

“…Details of our adaptation and implementation of the SICP are reported elsewhere. 9 The program consists of three main components: tools for clinicians, an educational component, and a system change component. Tools include a Previsit Letter for patients, the Serious Illness Conversation Guide and Clinician Reference Guide for clinicians, and a Family Communication Guide for patients and their families.…”

Section: Interventionmentioning

confidence: 99%

“…[5][6][7][8] To address these barriers and the gaps in communication practice identified in our previous work, [1][2][3] we undertook a quality improvement initiative to adapt and implement the Serious Illness Care Program (SICP) on the medical wards of several hospitals in Canada. 9 The SICP is a system-based communication intervention designed to improve the timing, quality, and frequency of conversations about values triggering clinicians to have serious illness conversations with eligible patients, delivering the conversation using the Guide, documenting the conversations in the medical record, giving participants the Family Communication Guide (Appendix 2) to support postconversation dialogue with family. The and goals with patients facing life-limiting illness.…”

Section: Introductionmentioning

confidence: 99%

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A Quality Improvement Initiative to Implement the Serious Illness Care Program on Hospital Medical Wards

You¹,

Singh²,

Simon³

et al. 2022

Can Journ Gen Int Med

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Background: The Serious Illness Care Program (SICP) is a communication intervention that builds clinician capacity to have earlier, more values-based conversations about goals of care with patients experiencing life-limiting illness. We report the impact of its implementation on hospital wards.Methods: In this quality improvement initiative on the medical wards of two Canadian teaching hospitals, we trained physicians, nurse practitioners, and social workers in the use of the Serious Illness Conversation Guide. Between February 2017 and September 2020, we prompted trained clinicians to have serious illness conversations with hospitalized patients or their family member(s), for patients at high risk of dying. Outcomes were the number of clinicians trained, the number of conversations delivered, patient or family experience, including the extent to which they felt heard and understood, and clinician experience.Results: We trained 57 (92%) of 62 eligible clinicians. We delivered conversations to 334 (29%) of 1158 eligible patients (or family members) and documented 274 (82%) of these in the medical record. After a serious illness conversation, 80% of patients or families rated the conversations as mostly or extremely worthwhile and felt more heard and understood (+0.2 on 5-point scale, P = 0.04). The majority (95%) of clinicians agreed (some-what, mostly, or completely) that conversations could be done in an appropriate amount of time and 97% agreed (somewhat, mostly, or completely) that the Guide provided information that enhances clinical care. Interpretation: The SICP can be implemented on medical wards of hospitals and can have a positive impact on patient and clinician experience. RésuméContexte : Le Serious Illness Care Program (SICP) est une intervention de communication qui renforce la capacité du clinicien à avoir des conversations plus précoces et davantage axées sur les valeurs concernant les objectifs des soins avec les patients atteints d’une maladie limitant leur espérance de vie. Nous présentons les répercussions de sa mise en œuvre dans les services hospitaliers.Méthodologie : Dans cette initiative sur l’amélioration de la qualité dans les services médicaux de deux hôpitaux universitaires canadiens, nous avons formé des médecins, des infirmières praticiennes et des travailleurs sociaux à l’utilisation du guide de conversation sur les maladies graves. Entre février 2017 et septembre 2020, nous avons incité les cliniciens formés à avoir des conversations sur les maladies graves avec des patients hospitalisés présentant un risque élevé de décès ou des membres de leur famille. Les critères d’évaluation étaient le nombre de cliniciens formés, le nombre de conversations effectuées, l’expérience des patients ou de leur famille, y compris la mesure dans laquelle ils se sont sentis écoutés et compris, et l’expérience des cliniciens.Résultats : Nous avons formé 57 (92 %) des 62 cliniciens admissibles. Des conversations ont été réalisées auprès de 334 (29 %) des 1158 patients (ou membres de la famille) admissibles et 274 (82 %) de ces conversations ont été consignées dans le dossier médical. Après une conversation sur les maladies graves, 80 % des patients ou de leur famille ont évalué les conversations comme étant plutôt ou extrêmement utiles et ils se sont sentis plus écoutés et compris (+ 0,2 sur une échelle de 5 points, P = 0,04). La majorité (95 %) des cliniciens sont d’accord (quelque peu, plutôt ou complètement) sur le fait que les conversations ont pu avoir lieu dans un laps de temps approprié et 97 % sont d’accord (quelque peu, plutôt ou complètement) sur le fait que le guide fournit des renseignements qui améliorent les soins cliniques.Interprétation : Le SICP peut être mis en œuvre dans les services médicaux des hôpitaux et peut avoir des répercussions positives sur l’expérience des patients et des cliniciens.

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Implementation of the Serious Illness Care Program on Hospital Medical Wards

Cited by 4 publications

References 26 publications

Recommendation‐making in the emergency department: A qualitative study of how Canadian emergency physicians guide treatment decisions about resuscitation in critically ill patients

Recommendation‐making in the emergency department: A qualitative study of how Canadian emergency physicians guide treatment decisions about resuscitation in critically ill patients

The Association of Standardized Documentation of Serious Illness Conversations With Healthcare Utilization in Hospitalized Patients: A Propensity Score Matched Cohort Analysis

A Quality Improvement Initiative to Implement the Serious Illness Care Program on Hospital Medical Wards

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