Animesh Sabnis1, Eunice Hagen2, Derjung M Tarn3, Lonnie Zeltzer4,5. 1. Division of Neonatology and Developmental Biology, Departments of Pediatrics, asabnis@mednet.ucla.edu. 2. Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California. 3. Family Medicine. 4. Anesthesiology, and. 5. Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California; and.
Abstract
OBJECTIVES: Timely multidisciplinary family meetings (TMFMs) promote shared decision-making. Despite guidelines that recommend meetings for all patients with serious illness, our NICU TMFM rate was 10%. In this study, we aimed to document a meeting within 5 days of hospitalization for 50% of all new NICU patients hospitalized for ≥5 days within 1 year of introducing interventions. METHODS: A multidisciplinary improvement team used the Model for Improvement to achieve the study aim by targeting key drivers of change. To make meetings easier, we introduced scheduling and documentation tools. To make meetings more customary, we provided education and reminders to professionals. We defined a TMFM as a documented discussion between a parent, a neonatologist, and a nonphysician professional, such as a nurse, within 5 days of hospitalization. We used statistical process control charts to assess the monthly proportion of new patients with a TMFM. In surveys and feedback sessions, family and clinician satisfaction with communication was assessed. RESULTS: TMFM documentation tripled during the intervention year when compared with the previous year (28 of 267 [10.5%] vs 70 of 224 [31.3%]; P < .001), revealing evidence of special cause variation on the statistical process control chart. Clinicians predominantly used ad hoc documentation instead of our scheduling and documentation tools. Parental satisfaction with care and communication did not vary significantly after interventions. Most physicians reported satisfaction with meetings. Nurses reported feeling empowered to request meetings. CONCLUSIONS: An academic, quaternary-care NICU tripled TMFM documentation after introducing a multifaceted intervention. This improvement may represent changes in professionals' attitudes about providing and documenting family meetings.
OBJECTIVES: Timely multidisciplinary family meetings (TMFMs) promote shared decision-making. Despite guidelines that recommend meetings for all patients with serious illness, our NICU TMFM rate was 10%. In this study, we aimed to document a meeting within 5 days of hospitalization for 50% of all new NICU patients hospitalized for ≥5 days within 1 year of introducing interventions. METHODS: A multidisciplinary improvement team used the Model for Improvement to achieve the study aim by targeting key drivers of change. To make meetings easier, we introduced scheduling and documentation tools. To make meetings more customary, we provided education and reminders to professionals. We defined a TMFM as a documented discussion between a parent, a neonatologist, and a nonphysician professional, such as a nurse, within 5 days of hospitalization. We used statistical process control charts to assess the monthly proportion of new patients with a TMFM. In surveys and feedback sessions, family and clinician satisfaction with communication was assessed. RESULTS: TMFM documentation tripled during the intervention year when compared with the previous year (28 of 267 [10.5%] vs 70 of 224 [31.3%]; P < .001), revealing evidence of special cause variation on the statistical process control chart. Clinicians predominantly used ad hoc documentation instead of our scheduling and documentation tools. Parental satisfaction with care and communication did not vary significantly after interventions. Most physicians reported satisfaction with meetings. Nurses reported feeling empowered to request meetings. CONCLUSIONS: An academic, quaternary-care NICU tripled TMFM documentation after introducing a multifaceted intervention. This improvement may represent changes in professionals' attitudes about providing and documenting family meetings.
Authors: Judy E Davidson; Rebecca A Aslakson; Ann C Long; Kathleen A Puntillo; Erin K Kross; Joanna Hart; Christopher E Cox; Hannah Wunsch; Mary A Wickline; Mark E Nunnally; Giora Netzer; Nancy Kentish-Barnes; Charles L Sprung; Christiane S Hartog; Maureen Coombs; Rik T Gerritsen; Ramona O Hopkins; Linda S Franck; Yoanna Skrobik; Alexander A Kon; Elizabeth A Scruth; Maurene A Harvey; Mithya Lewis-Newby; Douglas B White; Sandra M Swoboda; Colin R Cooke; Mitchell M Levy; Elie Azoulay; J Randall Curtis Journal: Crit Care Med Date: 2017-01 Impact factor: 7.598
Authors: Renee D Boss; Pamela K Donohue; Susan M Larson; Robert M Arnold; Debra L Roter Journal: Pediatr Crit Care Med Date: 2016-03 Impact factor: 3.624
Authors: Oluwakemi A Fawole; Sydney M Dy; Renee F Wilson; Brandyn D Lau; Kathryn A Martinez; Colleen C Apostol; Daniela Vollenweider; Eric B Bass; Rebecca A Aslakson Journal: J Gen Intern Med Date: 2012-10-26 Impact factor: 5.128
Authors: Martin D Black; Margaret C Vigorito; J Randall Curtis; Gary S Phillips; Edward W Martin; Lynn McNicoll; Therese Rochon; Susan Ross; Mitchell M Levy Journal: Crit Care Med Date: 2013-10 Impact factor: 7.598