IHI Expedition Palliative Care in the ED Session 5.ppt ... · new champions step up, processes...
Transcript of IHI Expedition Palliative Care in the ED Session 5.ppt ... · new champions step up, processes...
IHI Expedition: Palliative Care in the Emergency Department
Session 5
Tammie Quest, MD
Eric Bryant, MD
Kelly McCutcheon Adams, MSW, LICSW
These presenters have nothing to disclose
Today’s Host
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Kayla DeVincentis, Project Coordinator, has
worked at IHI since 2009, starting as an intern in
the Event Planning department. Since then, Kayla
has contributed to the STAAR Initiative, the IHI
Summer Immersion Program, and the IHI
Expeditions. Kayla obtained her Bachelor’s in
Health Science from Northeastern University and
brings her interest in health and wellness to IHI’s
Health and Fitness team.
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Overall Program Aim
The aim of this Expedition, Emergency Medicine and Palliative Care, is to help empower professionals to care for patients and families with palliative care needs in the emergency department setting.
The Expedition
Session #5: June 14th, 2012 1:30pm EST
� Achieving Change That Will Endure
Introducing Today’s Faculty
Tammie E. Quest, MD• Associate Professor, Emory University
School of Medicine, Department of
Emergency Medicine and Division of
Geriatric Medicine, Atlanta VAMC
• Director, Emory Palliative Care Center
• Director, Improving Palliative Care –
Emergency Medicine (IPAL-EM)
• Director, Education in Palliative and
End of Life Care – Emergency
Medicine
Introducing Today’s Faculty
Eric Bryant, MD• He earned an MA Public Policy Analysis from
the University of Colorado, Boulder and his
MD at the University of Pittsburgh Medical
School. He completed his residency in
Emergency Medicine at the Denver Health
Medical Center. He is Board Certified in
Emergency Medicine and Board Eligible in
Hospice and Palliative Medicine. He is a
member of the American Academy of
Hospice and Palliative Medicine and is a
Fellow of the American College of Emergency
Physicians (ACEP). He was President of the
Colorado Chapter of ACEP in 2008 and is
currently on the national ACEP Ethics
Committee.
Today’s Focus…
• Review Homework
• Explore New Content
�Achieving Change That Will Endure
• Close our expedition….
A Round of High Fives!
Homework Assignment
• Identify one priority area for improvement
with clinical documentation and monitoring
components to facilitate improvement
Achieving Change That Will
Endure
Case: The ED Champion
• A 20 bed emergency department employs a palliative care initiative with an ED clinician trained in palliative care to see consults in the ED and is the champion. Great impact is seen in care of patients as well as metrics first 2 years months. The ED champion unexpectedly moves for family reasons.
• After 3 months, the record gains that had been seen are no longer there.
Loss of a Champion
Month Number
MD Leaves
Case Study: Deep Dive
• What can we learn from a PC-ED initiative
that did not last?
• When an initiative is the work of a single
highly-motivated individual what happens
when that individual leaves?
Challenge to Sustaining Change
• Best case:
─ new champions step up,
processes continue, a new
chapter opens
• Worst case:
─ things fall apart, the overall
effort is set back due to
frustration, disappointment
and confusion
• Average case:
─ some awareness persists,
some early adaptors
continue to try, established
processes may continue
but without review and
revision
Strategies that Endure
BroadenDeepen
Enlighten
Broaden
• Build physician support beyond the initial
champion
• Build support beyond the physicians
Broaden
• Nurses, when empowered, are key:
─ For their bedside role
─ For their administrative role (departments and hospitals are run
by nurses)
• Social workers/Case managers:
─ disposition planning often highlights unmet PC needs
• Chaplains:
─ in addition to being resources for PC service are often critical
advocates for both the service and for individual referrals
Deepen
• Infiltrate
• Imbed
Deepen
• Don't just teach at staff meetings, participate in
processes such as QA/QI, M&M and Follow-up
processes
─ Review real cases that didn't go well to illustrate the
need for PC integration
─ Review real cases that went well to demonstrate the
potential
• Support compliance with system-wide quality and
compliance processes such as TJC accreditation
Embed
• Develop, add to or modify existing tools to
include PC best practices and trigger
referrals�Preformatted order sets
�Policies/procedures
Enlighten
• Bedside Teaching/Role modeling; Pocket
Cards
─Symptom management:
�Pain ("Pain 101", advanced pain management)
�Delirium Assessment and Management
�PC Emergencies
�Comfort care of the actively dying
�Communication
─Focus energy on early adopters
� Tips
• Grow a service, not just a practice
• PC needs to be seen not as something
"extra" for the ED to do or accommodate
but as integral to excellent emergency
care
• It will endure when it is part of the ED
culture and not just the passion of one
champion
Wrapping It all Up
Key Points: Session 1
“Getting Started”
Key steps to success:
1. Define the Problem (Needs Assessment)
2. Resource Inventory
3. Anticipate Barriers
4. Develop an Action Plan
Key Points: Session 2
Overcoming Barriers
I. Culture
II. Limited Skills and Knowledge
III. Time Constraints
IV. Environment
Key Points Session 3
Measurement
1. Complete a needs assessment
2. Select Metrics that are easily obtainable
3. Determine how often data should be
collected
4. Develop a system to report and use your
data
Key Points: Session 4Systems Design & Improvement Tools
• Key Questions:
─What changes are needed in clinical practice (including staffing)?
─How will these changes be captured and reflected in documentation?
─How will data be collected on measures of improvement?
Key Points: Session 5
• Deepen
• Broaden
• Enlighten
Follow up
• The listserv will remain active.
─To use the listserv, address an email to [email protected].
• A manual with instructions to receive
Continuing Education Credits will be sent
with the follow-up email for today's session.
• Please take 5 minutes to complete the
Expedition evaluation survey.
Thank you!