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Implementation of a Standardized Shared Decision-making Bundle to Improve Communication Practices in the
Hena Waseem1, Joshua Keegan1, Kelly Farrell1
1Dartmouth-Hitchcock Medical Center (HW, JK, KF, BO, RP, JM); The Dartmouth Institute for Health Policy and Clinical Practice (HW, BO), Geisel School of Medicine at Dartmouth; Yale School of Medicine (DYH); and University of North Carolina Medical Center (CO-S).
Neurology. Clinical Practice
|March 3, 2023
Summary
Implementing a standardized shared decision-making (SDM) bundle in neurocritical care improved documentation rates significantly. This quality improvement initiative enhanced patient-centered communication and goal alignment within the neurocritical care unit (NCCU).
Area of Science:
- Neurocritical Care
- Quality Improvement
- Health Communication
Background:
- Shared decision-making (SDM) is crucial for aligning patient preferences with healthcare goals.
- Existing SDM practices are challenging in neurocritical care units (NCCUs) due to unique demands.
- A quality improvement initiative aimed to implement a standardized SDM bundle in an NCCU.
Purpose of the Study:
- To implement and evaluate a standardized shared decision-making (SDM) bundle in a neurocritical care unit (NCCU).
- To improve the documentation of SDM conversations and enhance patient-centered care.
Main Methods:
- Utilized the Institute for Healthcare Improvement Model for Improvement with Plan-Do-Study-Act cycles.
- Developed an SDM bundle including team huddles, social worker-led conversations, and electronic medical record documentation.
- Primary outcome measure was the percentage of documented SDM conversations.
Main Results:
- Documentation of SDM conversations increased by 56% (from 27% to 83%).
- Average time to documentation decreased by 4 days (from 9 to 5 days).
- No significant changes in NCCU length of stay or palliative care consultation rates were observed.
Conclusions:
- A team-driven, standardized SDM bundle effectively improved the timeliness and documentation of SDM conversations in NCCU.
- This approach facilitates earlier alignment with patient and family goals, preferences, and values.
- SDM bundles have the potential to enhance communication and patient-centered care in complex neurocritical settings.
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