A Quality Improvement Initiative to Implement the Serious Illness Care Program on Hospital Medical Wards Impact on Patient and Clinician Experience

Main Article Content

John You
Japteg Singh
Jessica Simon
Irene W.Y. Ma
Joanna Paladino
Marilyn Swinton
Daniel Kobewka
Peter Munene
Dev Jayaraman
Fiona Dunne
Andrew Lagrotteria
Rachelle Bernacki

Keywords

hospital medicine, palliative care, advance care planning, quality improvement

Abstract

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.


Résumé
Contexte  : 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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