SHM Converge Scientific Abstract ePoster Gallery-Encouraging Serious Illness Conversations in the General Medicine Inpatient Setting

Pdf Summary

This study examined whether context-specific interventions could increase standardized documentation of Serious Illness Conversations (SICs) among high-risk patients admitted to a general medicine inpatient service at Brigham and Women’s Hospital. Although early SICs are known to improve patient satisfaction and support earlier hospice referral, they remain underused.<br /><br />Using an interrupted time series design, the investigators included adult encounters from January 2019 to October 2021 for patients with an elevated Epic Readmission Risk Score of at least 28%. The team used the CFIR framework to identify barriers and facilitators to SICs and the ERIC framework to design implementation strategies. They then evaluated whether these interventions changed the odds of SIC documentation over time using segmented logistic regression.<br /><br />The results showed no statistically significant immediate change or trend change in standardized SIC documentation after the interventions were implemented. In other words, the strategies did not measurably increase documentation rates in this population.<br /><br />The authors suggest several possible reasons for the lack of effect, including interventions that may have been insufficient or ineffective, as well as challenges related to the COVID-19 pandemic such as high patient census and clinician burnout. They conclude that continued support is needed to help clinicians conduct serious illness conversations, with the goal of promoting patient autonomy and better advance care planning.

Asset Subtitle

Myrna K. Serna

Meta Tag

Author List Anuj K. Dalal, Cathy Yoon, Jeffrey L. Schnipper, Joshua Lakin, Julie Fiskio, Myrna K. Serna

Category Research

Concept Serious Illness Conversation

Concept Advance care planning

Concept Interrupted Time Series

Concept Standardized Serious Illness Conversation Documentation

Concept Patient Satisfaction

Distinguished Non-Finalist

Presenter Organization University of Texas Medical Branch

Presenting Author Myrna K. Serna

Track Geriatrics

Keywords

Serious Illness Conversations

SIC documentation

implementation strategies

inpatient medicine

high-risk patients

interrupted time series

CFIR framework

ERIC framework

advance care planning

COVID-19 pandemic

Serious Illness Conversation

Advance care planning

Interrupted Time Series

Standardized Serious Illness Conversation Documentation

Patient Satisfaction