Serious Illness Conversations: A Case Management Quality Improvement Project

Area of Science:

• Healthcare Management
• Clinical Nursing
• Social Work Practice

Background:

• Effective management of serious illness (SI) requires specialized communication and care planning.
• Case management teams play a crucial role in coordinating care for patients with complex health needs.
• Standardized protocols are essential for consistent and high-quality SI care delivery.

Purpose of the Study:

• To develop and implement an educational program and SI protocol for case managers.
• To enhance the identification of patients with SI.
• To improve the elicitation and documentation of patient goals and preferences for SI care.

Main Methods:

• A 4-hour educational program was delivered to 20 case managers (nurses and social workers).
• Participants completed pre- and post-surveys assessing knowledge and confidence.
• A new SI protocol was implemented for patient identification, communication, and electronic medical record documentation.

Main Results:

• 95% of participants found the educational module objectives met.
• Statistically significant increases in post-program knowledge and confidence were observed.
• Case managers correctly identified 92% of SI patients and conducted conversations in 91.8% of cases, with 76% adherence to documentation standards.

Conclusions:

• The educational program and SI protocol effectively enhanced case managers' skills in SI care.
• The initiative led to improved patient identification, communication, and documentation of SI care preferences.
• This model offers a scalable approach to improving serious illness management within healthcare systems.