Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review
Abstract Background Patients in intensive care units (ICUs) often require quality palliative care for relief from various types of suffering. To achieve quality palliative care, specific goals need to be identified, measured, and reported. The present study aimed to develop quality indicators (QIs)...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40560-023-00713-z |
| _version_ | 1827382400202571776 |
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| author | Yuta Tanaka Kento Masukawa Hideaki Sakuramoto Akane Kato Yuichiro Ishigami Junko Tatsuno Kaori Ito Yoshiyuki Kizawa Mitsunori Miyashita |
| author_facet | Yuta Tanaka Kento Masukawa Hideaki Sakuramoto Akane Kato Yuichiro Ishigami Junko Tatsuno Kaori Ito Yoshiyuki Kizawa Mitsunori Miyashita |
| author_sort | Yuta Tanaka |
| collection | DOAJ |
| description | Abstract Background Patients in intensive care units (ICUs) often require quality palliative care for relief from various types of suffering. To achieve quality palliative care, specific goals need to be identified, measured, and reported. The present study aimed to develop quality indicators (QIs) for palliative care in ICUs, based on a systematic review and modified Delphi method, and test their feasibility by reviewing electronic medical record (EMR) data. Methods The current study was performed in two phases: the development of QIs using the modified Delphi method, and pilot-testing the quality of palliative care in ICUs based on EMR review. The pilot test included 262 patients admitted to the general or emergency ICU at a university hospital from January 1, 2019, to June 30, 2019. Results A 28-item QI set for palliative care in ICUs was developed based on the consensus of 16 experts. The Delphi process resulted in low measurability ratings for two items: "Assessment of the patient's psychological distress" and "Assessment of the patient's spiritual and cultural practices." However, these items were determined to be important for quality care from the perspective of holistic assessment of distress and were adopted in the final version of the QI set. While the pilot test results indicated the feasibility of the developed QIs, they suggested that the frequency of care performance varied, and certain aspects of palliative care in ICUs needed to be improved, namely (1) regular pain assessment, (2) identification of the patient's advance directive and advance care planning for treatment, (3) conducting an interdisciplinary family conference on palliative care, and (4) assessment of psychological distress of family members. Conclusions The QI set, developed using the modified Delphi method and tested using EMR data, provided a tool for assessing the quality of palliative care in ICUs. In the two ICUs considered in this study, aspects of the palliative care process with a low performance frequency were identified, and further national surveys were recommended. It is necessary to conduct ongoing surveys at more facilities to improve the quality of palliative care in ICUs. |
| first_indexed | 2024-03-08T14:19:00Z |
| format | Article |
| id | doaj.art-5044deea069d4a0f8e6b2ac785694046 |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-03-08T14:19:00Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-5044deea069d4a0f8e6b2ac7856940462024-01-14T12:13:28ZengBMCJournal of Intensive Care2052-04922024-01-0112111510.1186/s40560-023-00713-zDevelopment of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record reviewYuta Tanaka0Kento Masukawa1Hideaki Sakuramoto2Akane Kato3Yuichiro Ishigami4Junko Tatsuno5Kaori Ito6Yoshiyuki Kizawa7Mitsunori Miyashita8Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of MedicineDepartment of Palliative Nursing, Health Sciences, Tohoku University Graduate School of MedicineDepartment of Critical Care and Disaster Nursing, Japanese Red Cross Kyushu International College of NursingDepartment of Adult and Geriatric Nursing, School of Health Science, Shinshu UniversityDepartment of Transitional and Palliative Care, Aso Iizuka HospitalNursing Department, Kokura Memorial HospitalDepartment of Surgery, Division of Acute Care Surgery, Teikyo University School of MedicineDepartment of Palliative and Supportive Care, Institute of Medicine, University of TsukubaDepartment of Palliative Nursing, Health Sciences, Tohoku University Graduate School of MedicineAbstract Background Patients in intensive care units (ICUs) often require quality palliative care for relief from various types of suffering. To achieve quality palliative care, specific goals need to be identified, measured, and reported. The present study aimed to develop quality indicators (QIs) for palliative care in ICUs, based on a systematic review and modified Delphi method, and test their feasibility by reviewing electronic medical record (EMR) data. Methods The current study was performed in two phases: the development of QIs using the modified Delphi method, and pilot-testing the quality of palliative care in ICUs based on EMR review. The pilot test included 262 patients admitted to the general or emergency ICU at a university hospital from January 1, 2019, to June 30, 2019. Results A 28-item QI set for palliative care in ICUs was developed based on the consensus of 16 experts. The Delphi process resulted in low measurability ratings for two items: "Assessment of the patient's psychological distress" and "Assessment of the patient's spiritual and cultural practices." However, these items were determined to be important for quality care from the perspective of holistic assessment of distress and were adopted in the final version of the QI set. While the pilot test results indicated the feasibility of the developed QIs, they suggested that the frequency of care performance varied, and certain aspects of palliative care in ICUs needed to be improved, namely (1) regular pain assessment, (2) identification of the patient's advance directive and advance care planning for treatment, (3) conducting an interdisciplinary family conference on palliative care, and (4) assessment of psychological distress of family members. Conclusions The QI set, developed using the modified Delphi method and tested using EMR data, provided a tool for assessing the quality of palliative care in ICUs. In the two ICUs considered in this study, aspects of the palliative care process with a low performance frequency were identified, and further national surveys were recommended. It is necessary to conduct ongoing surveys at more facilities to improve the quality of palliative care in ICUs.https://doi.org/10.1186/s40560-023-00713-zQuality indicatorPalliative careCritical careIntensive careIntensive care units |
| spellingShingle | Yuta Tanaka Kento Masukawa Hideaki Sakuramoto Akane Kato Yuichiro Ishigami Junko Tatsuno Kaori Ito Yoshiyuki Kizawa Mitsunori Miyashita Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review Journal of Intensive Care Quality indicator Palliative care Critical care Intensive care Intensive care units |
| title | Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review |
| title_full | Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review |
| title_fullStr | Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review |
| title_full_unstemmed | Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review |
| title_short | Development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review |
| title_sort | development of quality indicators for palliative care in intensive care units and pilot testing them via electronic medical record review |
| topic | Quality indicator Palliative care Critical care Intensive care Intensive care units |
| url | https://doi.org/10.1186/s40560-023-00713-z |
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