ABCD Exchange : September - October 2000 : Resources - Improving Care for the End of Life : A Sourcebook

Upfront - Patient Safety and Medical Errors
Director's Chair - HIV/AIDS & End-of-Life Care
Pain - Pain Law Center Aims to Improve End-of-Life Care
QuickScan--News in Brief
On the Hill - Moyers on Dying

What Can You Do By Next Tuesday? Plenty, According to Improving Care for the End of Life : A Sourcebook for Health Care Managers and Clinicians
by Janice Lynch

Washington, DC - Dying patients suffer unwarranted pain, are at risk of unwanted procedures, and endure an unreliable care system. To improve care for seriously ill and dying patients, health care professionals will find guidance in Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians. The book chronicles the experiences of 47 health care organizations that participated in a Breakthrough Series collaborative project on Improving Care at the End of Life sponsored by the Institute for Healthcare Improvement (IHI) and by RAND’s Center to Improve Care of the Dying. Groups aimed for rapid-cycle improvements in four areas: advance care planning, continuity of care, pain and symptom management, and support for families and loved ones. Participants applied a “plan-do-study-act” model to target and solve problems in hospices, hospitals, and health care systems.

“The Breakthrough Series project was one of the most profound ever sponsored by the Institute for Healthcare Improvement,” Donald M. Berwick, M.D., president of IHI, said. “The Sourcebook allows other groups to enjoy a similar experience, and to do what matters most in health care: To care for patients and their loved ones.”

Co-author Joanne Lynn, M.D. noted, “Every group that set out to accomplish something, and stayed at it for a few months, did accomplish real change—they showed dramatic improvements over what they had done before. Groups solved important problems, such as how to get medication to patients more quickly or how to help families keeping vigil in an intensive care unit.”

The book describes how groups succeeded in changing care patterns that failed to serve sick patients. Teams learned to identify very sick patients by asking, “Would you be surprised if this person died within a few months?” rather than “Is he dying?” That simple question identified a broad group of patients who needed symptom control, advance planning, spiritual counseling, and other tailored services. The improvement teams that worked on pain often implemented routine assessment of “Pain as a Fifth Vital Sign, ” took steps to shorten response times to patient requests, and developed back-up medication kits for patients at home. Every team devised ways to measure and monitor the effects of their work, and the Sourcebook shows newcomers how to do the same. The Sourcebook shows readers how to adapt these changes in care patterns to their own practices or groups, and:

Excerpts from the Sourcebook can be read online at a site dedicated to helping professionals who want to make improvement happen in end of life wwww.medicaring.org/refer. Readers who want hands-on experience in a Breakthrough Series should check medicaring.org for information about a new Breakthrough Series scheduled to start in February 2001. The Sourcebook is available from Americans for Better Care of the Dying for $35, which includes shipping and handling. All proceeds go to ABCD to advance its work.

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This content is provided by Americans for Better Care of the Dying. For more information, visit www.abcd-caring.org.