Sabnis Animesh, Hagen Eunice, Tarn Derjung M, Zeltzer Lonnie
Division of Neonatology and Developmental Biology, Departments of Pediatrics,
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California.
Hosp Pediatr. 2018 Nov;8(11):679-685. doi: 10.1542/hpeds.2018-0070. Epub 2018 Oct 11.
Timely multidisciplinary family meetings (TMFMs) promote shared decision-making. Despite guidelines that recommend meetings for all patients with serious illness, our NICU TMFM rate was 10%. In this study, we aimed to document a meeting within 5 days of hospitalization for 50% of all new NICU patients hospitalized for ≥5 days within 1 year of introducing interventions.
A multidisciplinary improvement team used the Model for Improvement to achieve the study aim by targeting key drivers of change. To make meetings easier, we introduced scheduling and documentation tools. To make meetings more customary, we provided education and reminders to professionals. We defined a TMFM as a documented discussion between a parent, a neonatologist, and a nonphysician professional, such as a nurse, within 5 days of hospitalization. We used statistical process control charts to assess the monthly proportion of new patients with a TMFM. In surveys and feedback sessions, family and clinician satisfaction with communication was assessed.
TMFM documentation tripled during the intervention year when compared with the previous year (28 of 267 [10.5%] vs 70 of 224 [31.3%]; < .001), revealing evidence of special cause variation on the statistical process control chart. Clinicians predominantly used ad hoc documentation instead of our scheduling and documentation tools. Parental satisfaction with care and communication did not vary significantly after interventions. Most physicians reported satisfaction with meetings. Nurses reported feeling empowered to request meetings.
An academic, quaternary-care NICU tripled TMFM documentation after introducing a multifaceted intervention. This improvement may represent changes in professionals' attitudes about providing and documenting family meetings.
及时的多学科家庭会议（TMFM）可促进共同决策。尽管有指南建议为所有重症患者召开会议，但我们新生儿重症监护病房（NICU）的TMFM率仅为10%。在本研究中，我们旨在记录在引入干预措施后的1年内，50%入住NICU≥5天的所有新患者在住院5天内召开会议的情况。
一个多学科改进团队采用改进模型，通过针对关键变革驱动因素来实现研究目标。为了使会议更便捷，我们引入了日程安排和文件记录工具。为了使会议更常规化，我们为专业人员提供了教育和提醒。我们将TMFM定义为在住院5天内家长、新生儿科医生和非医生专业人员（如护士）之间进行的有记录的讨论。我们使用统计过程控制图来评估有TMFM的新患者的月度比例。在调查和反馈会议中，评估了家庭和临床医生对沟通的满意度。
与上一年相比，干预年的TMFM记录增加了两倍（267例中有28例[10.5%] vs 224例中有70例[31.3%]；P<0.001），在统计过程控制图上显示出特殊原因变异的证据。临床医生主要使用临时记录，而不是我们的日程安排和文件记录工具。干预后，家长对护理和沟通的满意度没有显著变化。大多数医生对会议表示满意。护士报告说有权力要求召开会议。
一家学术性的四级护理NICU在引入多方面干预措施后，TMFM记录增加了两倍。这种改进可能代表了专业人员对召开和记录家庭会议态度的转变。
