The Common Sense Guide to Improving Palliative Care > Assuring Comfort > 5.3 Identifying the Problem and Setting an Aim

Sick To Death book cover This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Identifying the Problem and Setting an Aim

The exact shape of your project will depend on your own situation and the problems that you identify. Because pain is one of the most common symptoms for advanced illness and at the end of life, many QI teams focus on relieving it. However, many other difficult symptoms, such as dyspnea or pressure ulcers, can be addressed using rapid-cycle QI. Here is a list of several target symptoms:

Common Symptoms

How to Identify Target Symptoms

After you have identified the symptoms that your system should improve, you should state your aim (see Chapter 2 for how to create an aim statement).

Team Breathe-Easy

Team Breathe-Easy wanted to meet the physical, psychosocial, and spiritual needs of its COPD patients and families; but that was a tall order, and too general to use as an aim. Realizing that they did not know where to start, they contacted 12 patients who had been readmitted to the COPD unit within 60 days of discharge and asked them two questions: Why had they come to the hospital? Could anything have enabled them to deal with the issue at home? The responses confirmed what Team Breathe-Easy had suspected: Patients and caregivers were not confident that they could do anything to manage symptoms at home. The team decided to better support symptom management at home as a way to reduce the experience of dyspnea and hospital readmission rate. The team agreed on the following aim statement to achieve its goal.

Aim: Within six months, 85% of advanced COPD patients discharged with comprehensive home-care services will be comfortable at home and will not be readmitted to the hospital within three months of discharge.

What will improve: Home-based symptom management, so that patients are comfortable at home and are not readmitted to hospital within three months of discharge.

By when: Within six months.

By how much: Eighty-five percent, rather than current rate of 50%.

For whom: Advanced COPD patients discharged with comprehensive home-care service.

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