Standardized goals for care enhance health care communication

It is important that your healthcare team recognizes and understands medical and personal care goals. However, that information, when documented, is not usually located in a standardized location and is difficult to find within the patient's vast electronic health records (EHR).

A new study by health researchers at the Regenstrief Institute, Indiana University School of Medicine, and Indiana University presents standardized goals for care notes they have developed, deployed and evaluated. This searchable note is located in a simple identification location in the EHR, providing convenient access to this important information for the clinician providing care.

The goal of a care conversation is one of the most important types of conversations with a patient, as it addresses the issue of being a patient, the most important thing to the patient. We really need to have a deep understanding of our patients' goals. This is especially true if a patient suffers from a life-threatening illness or has difficult decisions about what type of treatment to pursue.

These conversations should be documented where other clinicians can find them, when patients come to appointments, visit the emergency department, or admit to the hospital. That's why we developed the goals for care notes. ”

Alexia Torke, MD, MS, Advanced Study Author Regenstrief Institute and IU School of Medicine

Complementary, care note goals to advance care plan instructions often provide real-time details during the medical crisis and guide medical decisions.

The goals of the research team's newly developed care notes are to be continuously updated to ensure that the person's wishes, values, needs, beliefs and what is more important to each individual, or that the patient will share this information with their families. If you can't, you can refer to something more important to that person. Communication of patient preferences and values ​​is essential to ensuring both the quality of life and the quality of end-of-life care, says Dr. Torke.

In the first year after implementation of the care tool goal, 944 patients had this document in their EHR. Given the expertise of palliative care clinicians leading and documenting care conversation goals, the authors have detailed consideration of random selection notes from palliative care clinicians and random selections from other clinicians. We checked whether there were any differences in the documented ones. Despite the fact that there were no significant differences in demographic characteristics among patients with palliative care clinician goals and notes from other clinicians, the content and outcomes of care conversations were observed. The goals differed between trained palliative care clinicians and other clinicians.

The research authors are

Palliative clinicians recorded patient preferences, values, and religion more frequently than other clinicians in the care note goals (75% vs. 32%). Palliative care clinicians documented the patient's ability to make medical decisions more frequently than other clinicians (74% vs. 33%). Palliative care clinicians identified patients' legal decision makers more frequently than other clinicians (70% vs. 32%). Hospice was discussed by palliative care clinicians more than other clinicians (50% vs. 27%). The discussion of palliative care has resulted in higher hospice enrollment and suggested a choice of comfortable care before death (50% vs. 35%). Of the patients who died during the study, other clinicians wrote near-death care note goals compared to palliative care clinicians (4 days before death and 19th). A slower goal in care conversations may reduce the time for patients and families to prepare for the end of life.

Intensive care unit clinicians and hospital clinicians were most likely to record care goals after palliative care clinicians.

“Patients and families facing serious illnesses need to process a lot of information. Often, they have to make difficult decisions that they have never faced before, providing comfortable care. , and is uncertain about our goals, such as providing comfortable care,” said Dr. Torke. , palliative care physicians who explained that palliative care clinicians have three core elements. “We manage symptoms, for example, pain or shortness of breath. We provide emotional and mental support to patients and families when we are experiencing serious illness. Communication and medical decision-making. I will support you.”

Palliative care services are growing across almost every large health center, with many smaller services offering palliative care. Telehealth, such as IU Health Virtual Palliative Care Services, reaching patients across the state, has become an important resource in facilities without palliative care clinicians.

“Patients and their families are increasingly navigating complex healthcare environments across multiple specialties. Electronic health records are a tool to bridge communication gaps. Communication, including social and mental needs, We strive to bridge the gap and respect the preferences and values ​​of our patients,” said Shilpee Sinha, MD, IU Health and IU School of Medicine. Palliative Care Physician and co-founder of the Indiana Network for Hospice and Palliative Care. “This study informs us as we embark on the next stage of continuous improvement in patient-centered care delivery.”

This study was supported by IU Health and the IU School of Medicine.