Using Quality Improvement Science to Create a Navigator in the Electronic Health Record for the Consolidation of Patient Information Surrounding Pediatric End-of-Life Care
code status; documentation; electronic health record; end of life care; models of palliative care delivery; pediatrics
BACKGROUND: It is important to document the domains surrounding end-of-life (EOL) care in the electronic health record (EHR). No pediatric navigator exists for these purposes. MEASURES: Medical charts were reviewed for documentation surrounding code status and care at the time of death from January 2017 to June 2019. INTERVENTION: Creation of a navigator in the EHR to consolidate advance care planning documents, code status orders and notes and EOL flowsheets. OUTCOMES: After implementing the navigator, 96% code status changes had supporting documentation, an increase of 35%. The percentage of deaths supported by a psychosocial team (social worker, chaplain and certified child life specialist) increased by 25%. Post-mortem documentation became electronic. Patient level metrics began to be electronically collected. CONCLUSIONS/LESSONS LEARNED: Little has been published regarding use of the EHR to consolidate EOL documentation in pediatrics. Development of a systematic approach to documentation is critical to providing EOL care and standardizing care delivered.
Casas J; Jeppesen A; Peters L; Schuelke T; Magdoza NRK; Hesselgrave J; Loftis L
Journal of Pain and Symptom Management
2021
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1016/j.jpainsymman.2021.04.006" target="_blank" rel="noreferrer noopener">10.1016/j.jpainsymman.2021.04.006</a>
Palliative care, resuscitation status, and end-of-life considerations in pediatric anesthesia
advance care planning; code status; goals of care; pediatric anesthesia; pediatric palliative care
PURPOSE OF REVIEW: To familiarize pediatric anesthesiologists with primary palliative care procedural communication skills and recommendations for discussions involving complex medical decision-making or advance care planning, such as discussions about resuscitation status. RECENT FINDINGS: Recent publications highlight the benefits of pediatric palliative care (PPC) for seriously ill patients and their families, and how PPC principles might be applied to perioperative communication and decision-making. Both prospective and retrospective reports reveal improved quality of life, symptom management, and avoidance of unnecessary interventions when PPC is introduced early for a child with serious illness. SUMMARY: Pediatric anesthesiologists will, at some point, care for a child with serious illness who would benefit from PPC. It is important that all members of the perioperative care team are familiar with primary PPC procedural communication skills and models for approaching discussions about goals of care, shared decision-making, and advance care planning. Pediatric anesthesiologists should be incorporated as early as possible in team discussions about potential procedures requiring sedation for seriously ill children.
Erondu M U; Mahoney D P
Current opinion in anaesthesiology
2020
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1097/ACO.0000000000000860" target="_blank" rel="noreferrer noopener">10.1097/ACO.0000000000000860</a>
The triad that matters: palliative medicine, code status, and health care costs.
Female; Humans; Male; Aged; Middle Aged; Equipment and Supplies; hospice; Patient Admission; Emergency Service; 80 and over; retrospective studies; DNAR; DNAR Outcomes; Surgical Procedures; Critical Illness/ep [Epidemiology]; Palliative Care/ut [Utilization]; Critical Illness/ec [Economics]; Emergency Service; Hospital Costs/sn [Statistics & Numerical Data]; Intensive Care/ec [Economics]; Length of Stay/ec [Economics]; Palliative Care/ec [Economics]; Code status; Direct Service Costs/sn [Statistics & Numerical Data]; health care cost; Hospital/ec [Economics]; Hospital/ut [Utilization]; Intensive Care/ut [Utilization]; Laboratories; Length of Stay/sn [Statistics & Numerical Data]; Operative/ec [Economics]; palliation; Radiology Department; Respiratory Care Units/ec [Economics]; United States/ep [Epidemiology]
INTRODUCTION: Delayed discussion of a patient's code status can lead to shortsighted care plans that increase hospital length of stay (LOS) and costs., METHODS: Retrospective study compared intensive care unit (ICU) patients who accepted verses rejected palliation and examined the relationships between 5 predictor variables with the outcome variables ICU LOS and total hospital LOS, and total direct and variable hospital cost., RESULTS: A significant number of patients who accepted palliative care agreed to a hospice referral or expired in the hospital. The relationships between days until a family conference, do-not-resuscitate (DNR) order, and the number of invasive procedures were significant., CONCLUSIONS: The amount of time that expires until the issue of code status was settled to clearly related to utilization of hospital resources.
2010
Celso BG; Meenrajan S
The American Journal Of Hospice & Palliative Care
2010
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1177/1049909110363806" target="_blank" rel="noreferrer">10.1177/1049909110363806</a>
Documentation of code status and discussion of goals of care in gravely ill hospitalized patients
end of life; Code status; Goals of care; Medical education
Background Timely discussions about goals of care in critically ill patients have been shown to be important. Methods We conducted a retrospective chart review over 2 years (2003-2004) of patients admitted to our medical service who were classified as “expected to die.” Charts were evaluated for do-not-resuscitate (DNR) documentation and discussions of goals of care. Detailed chart reviews for demographic information, cause of death, site of death, length of stay, and duration of resuscitation attempt were performed. Results Of 497 charts identified, 434 (87.3%) had a DNR on file at the time of death. After exclusion of patients who died in less than 24 hours, 18 no-DNR charts remained. Seven noted a decision to continue aggressive care and 11 had no code status discussion documented. Younger patients and patients with cardiovascular disease were less likely to have a DNR. Resuscitation times were longer in the no-discussion group. All patients who died without a DNR died in the intensive care unit. Seventy-six percent of discussions were done by medicine housestaff. Conclusions Although the overall rate of DNR documentation was high, several trends emerged. Medicine housestaff in the intensive care unit would be a logical group to target for an educational intervention to address these discrepancies.
2009-06
Holley A; Kravet SJ; Cordts G
Journal Of Critical Care
2009
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/j.jcrc.2008.03.035" target="_blank" rel="noreferrer">10.1016/j.jcrc.2008.03.035</a>