VA Connecticut Healthcare System, West Haven and Yale University School of Medicine, New Haven, Connecticut, USA.
VA Puget Sound Healthcare System and University of Washington School of Medicine, Seattle, Washington, USA.
J Pain Symptom Manage. 2019 Dec;58(6):1075-1080. doi: 10.1016/j.jpainsymman.2019.08.015. Epub 2019 Aug 20.
We sought to increase intensive care unit-family meeting (ICU-FM) documentation in the electronic health record in Veterans Affairs (VA) hospitals.
Primary outcomes were proportion of VA decedents with ICU-FM and Bereaved Family Survey-Performance Measure (BFS-PM) scores of "excellent."
Quality improvement (QI) project, clinical champion, and ICU-FM templates were implemented in nine participating VA facilities. ICU-FMs and BFS-PM were determined in decedents between 2011 and 2018.
ICU-FM increased from 3% to 28% in participating vs. 5% to 6% in nonparticipating facilities over time. Participating facilities were five-fold more likely to have ICU-FMs among ICU decedents (OR = 5.69, [4.45-7.28]). Facility-wide excellent BFS-PM scores increased by 19% in participating vs. nonparticipating facilities at the end of the observation period (OR = 1.19, [1.10-1.30]), but no difference between groups was observed in patients who died in the ICU.
Increasing ICU-FMs is necessary but not sufficient to improve family-reported satisfaction after an ICU death.
我们试图增加退伍军人事务部（VA）医院电子健康记录中重症监护室-家庭会议（ICU-FM）的记录。
主要结果是 ICU-FM 和悲痛家属调查-绩效衡量（BFS-PM）评分“优秀”的 VA 死者比例。
在九个参与的 VA 设施中实施了质量改进（QI）项目、临床冠军和 ICU-FM 模板。在 2011 年至 2018 年期间，确定了死者的 ICU-FM 和 BFS-PM。
与非参与设施相比，参与设施的 ICU-FM 从 3%增加到 28%，而非参与设施从 5%增加到 6%。参与设施的 ICU 死亡患者中有 ICU-FM 的可能性是其他设施的五倍（OR=5.69，[4.45-7.28]）。在观察期末，参与设施的整体优秀 BFS-PM 评分增加了 19%，而非参与设施增加了 19%（OR=1.19，[1.10-1.30]），但在 ICU 死亡的患者中，两组之间没有差异。
增加 ICU-FM 是必要的，但不足以提高 ICU 死亡后家属报告的满意度。
