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- W3001981057 abstract "•Describe a novel approach for reducing unwanted intensive care unit transfers in hospitalized patients.•Describe the results of a multicomponent, multidisciplinary intervention to increase advanced care planning in hospitalized patients. Goals of care (GOC) discussions are not consistently occurring in hospitalized patients at high risk for rapid response activation (RRT) and intensive care unit (ICU) transfer, leading to unwanted ICU transfers. We aimed to decrease by 25% the number of patients brought to the ICU via RRT and transitioned to comfort care within 72 hours without decreasing the number of RRTs activated. Decreasing the number of patients brought to the ICU and quickly transitioned to comfort care by increasing the rate of GOC discussions ensures goal-concordant care is provided. Through stakeholder interviews, we identified factors contributing to patients being transferred to the ICU via RRT and rapidly transitioned to comfort care: GOC conversations were not occurring in patients admitted to the hospital at high risk for clinical deterioration; when GOC discussions did occur, they were not easily identified in the medical record; and treatment options were not clear to patients. To target these, we created a multicomponent intervention. Care Management identified high-risk patients and reported this on rounds. The patient then received an education tool describing treatment options along with a conversation guide. Providers would then have a GOC conversation, and document this in an Advanced Care Planning note. Prior to the intervention, 13.5% (nine patients out of 65 over a 120-day period) of patients with an RRT call were transferred to the ICU and transitioned to comfort care within 72 hours in comparison to 8.3% (four patients out of 54) of patients following the intervention—a 44.4% reduction. The average number of RRTs activated per day pre- and postintervention was similar (0.54 per day and 0.45 per day, respectively). A multicomponent intervention that identifies high-risk patients and educates patients on GOC conversations can improve goal-concordant care." @default.
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- W3001981057 date "2020-02-01" @default.
- W3001981057 modified "2023-10-16" @default.
- W3001981057 title "Patient-Driven Goals for High-Risk Hospitalized Patients (QI637)" @default.
- W3001981057 doi "https://doi.org/10.1016/j.jpainsymman.2019.12.246" @default.
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