Philip Dela Cruz, n/a
Resident Physician
UHS SoCal MEC Internal Medicine Residency, United States
Disclosure information not submitted.
Obinna Ome Irondi
George Washington University School of Medicine & Health Sciences
Arlington
Disclosure information not submitted.
Danielle Davison, MD
Associate Professor of Anesthesiology and Critical Care Medicine and of Medicine
George Washington University Medical Center, United States
Disclosure information not submitted.
Erica Schockett, MD
Assistant Professor
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
David Yamane, BS, MD
Assistant Professor of Emergency Medicine, Anesthesiology, and Critical Care Medicine
George Washington University Hospital, United States
Disclosure information not submitted.
Erin Jackson, MD
Assistant professor
George Washington University School of Medicine and Health Sciences, United States
Disclosure information not submitted.
Title: Analysis of Explicit Verbal Discussions in the ICU: Can We Teach Doctors Primary Palliative Skills?>
Introduction:
Palliative medicine focuses on providing relief from the symptoms and strains of illness, and any
provider can learn and utilize basic palliative skills. Primary palliative skills are essential for
providing quality care to patients, critically ill or not. Primary palliative care topics should routinely be discussed amongst the ICU care team to provide a patient-centered plan. However, not all practitioners are adequately trained to consistently verbalize these topics during rounds, resulting in missed opportunities to provide optimal serious illness care. The goal of our study was to determine whether training from a skilled palliative specialist would improve the frequency of explicit discussion of palliative topics during multidisciplinary critical care rounds.
Methods:
We conducted a pre and post intervention single-blinded study at a single urban academic medical center ICU. Pre-intervention observations occurred from Jan 1 - Feb 6, 2021. Post-intervention observations occurred from Apr 6 - Jun 1, 2021. ICU Rounds were secretly observed for explicit verbalization of advance directives, goals of care, communication with family, plans for family meetings, pain levels, and pain management. After initial data collection, a skilled palliative physician provided training to the observed residents, students, and attending physicians, consisting of prompted discussions tailored to each patient regarding these quality domains. The palliative physician was also available for formal consultation if indicated.
Results:
272 pre-training and 162 post-training assessments were performed. Significant increases were found in: patients’ goals of care (8.1% vs 17.3%, p < 0.01); communication with family (27.6% vs 37.0%, p = 0.04); plans for family meetings (8.5% vs 25.9%, p< 0.01); pain levels (19.5% vs 44.4% p < 0.01); pain management (19.5% vs 44.4%, p< 0.01). No significant change was found in discussion of an advance directive.
Conclusions:
Primary palliative skills training from a palliative care specialist can have a statistically significant positive impact on explicit verbal discussion during ICU rounds. Early exposure to primary palliative skills training may improve physicians’ abilities to systematically implement primary palliative domains of quality serious illness care into daily rounds.