Project Details
About the Project
This initiative, having completed its second phase SIFEI funding, focused on improving care for the frail elderly inpatient population who are at or nearing the natural end of their life. Driven by concerns that the high number of medical and surgical procedures delivered to this population are unwanted and harmful, the project focused on giving meaning to MOST M2 in hospital, as a step down from M3, for patients wishing to have only minimally-invasive medical care, with a focus on quality of life and comfort. By increasing physician expertise in having Goals of Care discussions with patients and their families and documenting the outcomes of these conversations in the Advanced Care Planning power form in Cerner, the team hoped to improve goal-concordant care for our frail and advanced elder population.
To accomplish this, a multidisciplinary working group was formed, comprised of Dr. Chloé Lemire-Elmore (Hospitalist), Dr. Brian McArdle (GIM), Dr. Jody Anderson (Palliative), Dr. Vanja Petrovic (GIM), Dr. Josh Budlovsky (Geriatrics), Lisa Cairns (Public Health, International Health, Med Ed), Dr. Adam Thomas (ICU, ED), Dr. Shavaun MacDonald (ICU, Ethics, Med Ed), Dr. Tristan Jones (ED), and Dr. Ali Yakshi Tafti (ED). Dr. Margaret Manville (Medical Director for Long Term Care), the division heads for hospitalist medicine at both RJH and VGH, and surgical lead at RJH Dr. Nadra Ginting were also involved.
One of the primary change ideas was to raise awareness about MOST M2 through a series of ‘Flash Focus’ luncheons with the hospitalist service at both VGH and RJH. Through these, various interrelated concepts were shared, such as “Meaning of MOST M2”, and “De-escalating Care – Deprescribing”. In reviewing the data, the team noted a significant, near doubling, rate of MOST M2 being used before and after these initiatives, along with a tripling of documented Goals of Care conversations it the Advanced Care Planning Power Form – making them visible to all providers, across encounters.
Moving forward, the team aims to spread this initiative to Saanich Peninsula Hospital and then explore spread to other sites within Island Health, with further plans to spread to sites in Vancouver Coastal Health. Ongoing data collection efforts will explore impacts of this initiative on nursing awareness, and on the intensity of labs, diagnostics and therapeutics for inpatients who died in hospital in the weeks leading up to their death, and for those who were discharged to LTC with a MOST M2 as compared with MOST M3 status. With these efforts, the goal of providing dignified, end of life care for the frail elderly is increasingly within reach.