Sourcebook : 6.7 Offer Bereavement Counseling and Services in All Settings : 6.7.2 Case Study - University of Utah Hospital

The Breakthrough Series team at the University of Utah Hospital in Salt Lake City aimed to improve supportive care to families whose loved ones had died in the hospital; the specific goal was to provide follow-up supportive care to at least one family member of all patients who had died within the four hospital units involved in the Breakthrough Series.

Changes tested included establishing end-of-life teams on these units, including the ICU and the neuro-critical care unit. Each unit tailored its involvement based on the patients in its care. All agreed to try three targeted interventions that could be measured:

1. Within one to two weeks of death, a unit nurse would send a family member a "thinking of you" card.
2. Within one month, a nurse or doctor on the unit would call a family member and tell them that an information packet about grief and grief support resources would be mailed.
3. Within six weeks, a follow-up packet, including a letter from the unit staff, a list of common grief responses, and a list of bereavement services in Utah, would be mailed.

Nurses found that the telephone calls were difficult to make: The additional time and effort required by the calls sometimes forced them to extend their work hours or come in on days off. Nurses were anxious about what to do should the family seem to need help, so nurses were given a list of crisis center phone numbers in each Utah county. A script was drafted for nurses. When families were reached, they seemed to appreciate the contact.

The cards and packets, although slightly more time-consuming, were completed more frequently. This was accomplished, in part, by a committed volunteer, who donated many hours of service to the project. To the group's surprise, not all patients had a home address - for instance, those who had arrived from nursing homes and prisons or who were homeless had no address or next-of-kin to contact.

By the end of the Breakthrough Series, most units were sending cards to all families, some of whom sent notes of appreciation. During the study period, 91 patients died in the four units. Nurses' follow-up efforts were an important intervention, and both patients and staff expressed appreciation for the interaction. Families appreciated the extra effort, and nurses felt a sense of completion in the care they had provided. In the past, staff had wanted to follow up with families but had no organized method for doing so.

The University of Utah Hospital is building on work accomplished by the Breakthrough Series team, appointing a Bereavement Coordinator who is working with the hospital to develop grief and bereavement services.

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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved. For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].