Conversation Ready: Rethinking Care at the End of Life
A pioneer member of the Conversation Ready project, Beth Israel Deaconess Medical Center is developing new ways to reach out to patients, and record, retrieve and respect their wishes about care in their last days.
Susan Johnson didn’t expect to end up in the intensive care unit at BIDMC. But when she did, she found herself unprepared, in many ways.
At her bedside, her husband Jerry felt overwhelmed at the sight of the woman with whom he had spent his life hooked up to bedside machines. After all these years, he knew her so well, but realized he did not know what kind of care she would want if her condition worsened. That conversation was something they had not shared.
Fortunately, Susan recovered, and end-of-life care wasn’t something Susan’s family needed to struggle with this time. But Susan resolved to never put herself and her family in this predicament again.
“After I got out of the hospital, I did a lot of thinking,” Susan says. “I wanted the main players in my life to know what I want in case that happens again. I don’t want them to feel guilty. I want them to see on paper that they’re just speaking for their mom.”
For many, a second chance at sharing one’s wishes for end-of-life care doesn’t present itself. But BIDMC has joined an effort to lead change on this front. Two years ago, BIDMC became one of 10 national Conversation Ready Pioneers working with the Institute for Healthcare Improvement and The Conversation Project to improve the way clinicians provide care as people near the end of their lives. The Conversation Project also calls on patients and families, such as Susan’s, to become “conversation ready” by talking openly about end-of-life care before it’s too late.
Lachlan Forrow, MD, Director of Palliative Care Consultation Services at BIDMC and a member of BIDMC’s Conversation Ready team, recently shared his experience in a stirring Boston Globe spotlight featuring Ros Abercrombie, a 76-year-old BIDMC patient in the final stages of congestive heart failure. As the article describes, Abercrombie wanted to spend her last days in the comfort of her own home, with her adult children and her cat, but some of her children didn’t want to talk about the possibility of her dying. Her BIDMC care team helped Ros and her family have the conversations they needed to have, and when she died peacefully at home, all her children took pride in having helped ensure her final moments were exactly as she had wanted.
“When you lose someone you love, it’s a very sad death,” Forrow told the Boston Globe. “But when you’ve done things right, you know the last part of their life was the best it could possibly be.”
Technology and the 4 Rs
BIDMC’s Conversation Ready team is guided by a memorable mantra — the four Rs:
- Reach out to patients about what matters most to them regarding end-of-life care
- Record those wishes in the medical record
- Retrieve that information from the medical record when it is needed, and thereby
- Respect patients’ wishes and preferences
Now, a new addition to a patient’s electronic medical record has introduced functions that do just that: record and display documentation related to advance care planning, including a patient’s end-of-life care wishes, all in one place.
“This new functionality is part of providers’ workflow, easy to use, and helps make the most of the work they’re already doing,” says Lauge Sokol-Hessner, MD, Associate Director of Inpatient Quality and project lead for Conversation Ready. “After we reach out to form relationships with our patients and understand what matters most to them, we now have a way of recording that information so it’s easy for future providers to retrieve it. In the setting of serious illness, preparing in advance for exacerbations or progression is an essential part of respecting our patients’ wishes.”
“The new page in the medical record is a huge step forward for us in team communication around advance care planning,” says Marc Cohen, MD, a physician with HealthCare Associates at BIDMC. “It provides one centralized place for outpatient and inpatient team members alike to document and share information about our patients’ wishes. It allows us to have the information that is key to respecting our patients’ wishes along with their care experience in an up-to-date, ‘one click away’ format embedded within the systems we are already using. It is a true win in terms of supporting these conversations, and being sure that we capture the information in a usable way once conversations occur.”
BIDMC is committed to helping patients, providers and staff become “conversation ready.” If you have questions about the Conversation Ready project or would like to get involved, learn more at bidmc.org/conversationready.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.