Lehigh Valley Hospital and Health Network

Project Overview:

Title: Lehigh Valley Hospital Critical Care Palliative Care Project

The Lehigh Valley Hospital and Health Network (LVHHN) project implemented and evaluated a palliative care model in three Intensive Care Units (ICUs) -- Medical, Surgical and Trauma Units. A 689-bed academic community hospital (with 84 critical care beds), LVHHN is a major clinical campus for Penn State University's College of Medicine, and has affiliations with local nursing and allied health schools and a physician assistant program. The palliative care model for this intervention envisioned family-centered decision making, improved communication with the patient/family and appropriate continuity of care on discharge from the ICU. Co-Principal Investigators for the project were Daniel Ray, M.D. and Cathy Fuhrman, R.N.

Lehigh Valley Hospital and Health Network's project proposed a cultural change fusing palliative care practices with ICU practices. The intervention was first introduced and refined in the Medical ICU, and then implemented in the Surgical ICU and Acute Care Units, using a quality improvement format.

Goals of the project were:

  • Implement a palliative care model for all patients admitted to the medical critical care unit;
  • Conduct staff education in palliative care;
  • Implement communication tools; and
  • Evaluate the model.

The project developed the following palliative care model interventions for family comfort:

  • Improvements to ICU waiting room and development of an Ambassador program;
  • Modified visiting hours;
  • Formation of a weekly family support group;
  • Implementation of a volunteer program similar to the No One Dies Alone program in Eugene, Oregon; and
  • Post-ICU referral to hospice program bereavement services.

The education component included:

  • Core curriculum development:
  • Re-formatted order set for palliative care issues;
  • CA POE;
  • Nursing staff-specific education;
  • Physician staff-specific education;
  • Palliative Care Symposium;
  • Grand rounds on palliative care issues;
  • Resident house staff-specific education;
  • Family and patient education; and
  • Community education.

The communication component included:

  • Multi-disciplinary rounds;
  • Nursing empowerment;
  • Chart documentation of family meeting;
  • Medical Staff Progress Notes; and
  • Family mailbox and communication boards.

The evaluation component included:

  • Critical Care Family Satisfaction Survey (all families); and
  • Quality of Dying and Death (death on unit - patient families & nurses).

Other intervention components were:

  • Palliative Care Advisory Group; and
  • Dedicated ICU Chaplain - 20 hours/week in ICU.

Dr. Ray explains the LVHHN model, "Using components and processes such as interdisciplinary rounding (with pastoral care and optional family participation), palliative/curative care planning (within 24 hours of admission) and formalized patient/family shared decision making, each admission to the ICU was provided the education and support needed to improve the quality of experience in the ICU for patients and their families - in medical, psychosocial and spiritual domains."

Tools

Resources

Related Resources:

Critical Care Workgroup

Lessons Learned:

  • Develop the waiting room as a resource for families. The waiting room experience often defines the family's perception of care provided within the walls of the ICU.
  • Use nurses as local champions for a palliative care program. Nurses have a good understanding of palliative care and its relationship to end-of-life care. Nurses identify the greatest impediment to effective palliative care is physicians' unwillingness or inability to formulate and communicate prognosis.
  • Improve the family experience with open visiting hours. This doesn't necessarily mean open access.
  • Focus on communication. Communication is an important component of a successful intervention. Methods implemented in this project to enhance communication were brochures to educate families about the ICU process, and holding family meetings within 48 to 72 hours.
  • Get hospital administration "on board" with the project before beginning.
  • Encourage physicians to receive certification in palliative care. This increases the capacity of the system to provide care, and increases the critical mass moving palliative care initiatives forward.
  • Implement protocols to make "the right way the easy way" (for example, protocols for delirium and agitation).
  • Do spiritual assessments for patients and families.

Team Members

Daniel E. Ray, M.D., Principal Investigator
Lehigh Valley Hospital and Health Network
Pulmonary/Critical Care Medicine

Cathy Fuhrman, R.N., Principal Investigator
Palliative Care Program Coordinator
Lehigh Valley Hospital and Health Network

Darrell Arnold
Senior Research Coordinator
Lehigh Valley Hospital and Health Network

Lynn Dietrich, R.N., Ph.D.
Senior Scientist, Ethnographer
Lehigh Valley Hospital and Health Network

Jack Geracci, R.N., M.Div.
ICU Chaplain
Lehigh Valley Hospital and Health Network

Brian Kerecz
IT Specialist
Lehigh Valley Hospital and Health Network

Joan M. Schultes, R.N., B.S.
Case Manager, MICU/SICU
Lehigh Valley Hospital and Health Network

W. Glenn Stern, M.A.
Grant Scientist
Lehigh Valley Hospital and Health Network

Thomas Wasser, Ph.D.
Chief of Research, Senior Biostatistician
Lehigh Valley Hospital and Health Network

Contact Information:

Daniel E. Ray, M.D., Principal Investigator
Lehigh Valley Hospital and Health Network
Pulmonary/Critical Care Medicine
1200 S. Cedar Crest Blvd.
Allentown, PA 18105
Phone: 610.439.8856
Fax: 610.439.1314
Daniel.Ray@lvh.com

Cathy Fuhrman, R.N., Principal Investigator
Palliative Care Program Coordinator
Lehigh Valley Hospital and Health Network
P.O. Box 689
Allentown, PA 18105
Phone: 610.402.8585
Fax: 610.402.1240
Cathy.Fuhrman@lvh.com

Web site:
http://lvhhn.org/services/excellence/palliative_care

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Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families.