The New York City Palliative Care Quality Improvement Collaborative

Gould, David; Lynn, Joanne; Halper, Deborah; Myers, Sarah; Simon, Lin; Holmes, H. R.

doi:10.1016/s1553-7250(07)33035-3

Cited by 9 publications

(6 citation statements)

References 4 publications

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“…48,49 Elements that contribute to successful organizational change include strong leadership support and sponsorship, development of a consistent organizational model, networking and information sharing among providers, engagement of the staff to collaborate in teamwork to test initiatives, and availability of performance data that feed back to organizational leaders to sustain changes. 50,51 Inadequate hospital policies on DNR discussion standards.…”

Section: Reasons For Inadequate Dnr Discussion and Recommended Stratmentioning

confidence: 99%

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

2011

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Do-not-resuscitate (DNR) orders have been in use in hospitals nationwide for over 20 years. Nonetheless, as currently implemented, they fail to adequately fulfill their two intended purposes-to support patient autonomy and to prevent non-beneficial interventions. These failures lead to serious consequences. Patients are deprived of the opportunity to make informed decisions regarding resuscitation, and CPR is performed on patients who would have wanted it withheld or are harmed by the procedure. This article highlights the persistent problems with today's use of inpatient DNR orders, i.e., DNR discussions do not occur frequently enough and occur too late in the course of patients' illnesses to allow their participation in resuscitation decisions. Furthermore, many physicians fail to provide adequate information to allow patients or surrogates to make informed decisions and inappropriately extrapolate DNR orders to limit other treatments. Because these failings are primarily due to systemic factors that result in deficient physician behaviors, we propose strategies to target these factors including changing the hospital culture, reforming hospital policies on DNR discussions, mandating provider communication skills training, and using financial incentives. These strategies could help overcome existing barriers to proper DNR discussions and align the use of DNR orders closer to their intended purposes of supporting patient selfdetermination and avoiding non-beneficial interventions at the end of life.KEY WORDS: do-not-resuscitate orders; informed consent; end-of-life care.

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Section: Reasons For Inadequate Dnr Discussion and Recommended Stratmentioning

confidence: 99%

Hospital Do-Not-Resuscitate Orders: Why They Have Failed and How to Fix Them

2011

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“…Examples include timely referrals to palliative care, reduced emergency department admissions, decreased length of stay in hospital, and an increase in the proportion of deaths at home or in a non-acute care facility. [35][36][37][38] Given this background of less than optimal support for family caregivers and limited interventions to assist this population, we aimed to develop guidelines for the psychosocial and bereavement support of family caregivers of palliative care patients. The primary target audience for the guidelines were multidisciplinary health care professionals commonly involved in caring for adult patients receiving specialist palliative care (home, hospital, hospice) throughout Australia.…”

Section: Introductionmentioning

confidence: 99%

Guidelines for the Psychosocial and Bereavement Support of Family Caregivers of Palliative Care Patients

Hudson

Remedios

Zordan

et al. 2012

Journal of Palliative Medicine

159

182

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“…[13][14][15] MRPCI confirmed the feasibility of building palliative care capacity in rural communities using a framework of community capacity development theory, a learning collaborative, and the NQF preferred practices for palliative care. The unique nature of rural communities impacted both successes and challenges.…”

Section: Discussionmentioning

confidence: 81%