Re-envisioning EMR: Process and Outcome

Transcription

1 Re-envisioning EMR: Process and Outcome Marie Parker RSM Director of Mission and Spiritual Care Trinity Health Kay Gorka BCC Manager of Spiritual Care Providence Health Care

2 CHA PCAC Quality Work Group As Catholic health care providers, we offer quality person-centered care that attends to the mind, body and spirit. It is in that context we offer three areas for measuring quality in spiritual care. 2

3 Quality Integration Performance Aligned With Standards 3

4 Process Measures 1. Process Measure - a measure which focuses on a process that leads to a certain outcome. Can you answer the questions: - Did you do it (services complete)? - Did you do it right? - Is process designed and implemented to gather the identified elements? 4

5 Outcome Measures 2. Outcome Measures a measure of the results of a system, relative to aim. Can you answer the question: - Did the process you completed get the outcome desired/expected? - Are provisions made to continue to update, improve, review outcomes? 5

6 Performance Against Standards 3. Performance Aligned With Standards Can you answer the question: - What are the measurable standards agreed upon across the profession that demonstrate effectiveness in Spiritual Care? 6

7 One System s Journey

8 2, 4, 12

9 Goals To use standardized documentation that would work for any Chaplain, in any assignment, in both hospitals To document a quality spiritual care encounter in the EMR To have the Chaplain documentation valued by the interdisciplinary team

10 Process Part 1: Met monthly with 2 teams, and individual chaplains to evaluate charting format to answer the questions: What Works What are the barriers Completed Chart audits Was the charting format used? Are the quality measures met?

11 Quality Measures

12 Involved Interdisciplinary Team Part 2 Asked the Palliative Care Team for feedback, which included, 3 MDs, 4 ARNPs, 2 RNs, and 1 SW Do you read our chart notes? Do you find them valuable to your work? What about the note is meaningful to you?

13 In the beginning Started with HOPE Sources of hope, meaning, comfort, strength, peace, love and connection Organized religion Personal spirituality and practices Effects on medical care and end of life issue

14 HOPE- What Worked: Palliative Care Team Feedback They were reading the notes, when they consulted a Chaplain, and during chart audits Found the information they needed with ease Found the articulation of the impact on healthcare was meaningful to their work Found the specific information about patient and family s concerns and hopes to be helpful

15 Chaplain Feedback Barriers to HOPE Only 5 Chaplains charted using this format (Palliative Care, ICU, Pediatric Chaplain) Did not work for patients/families of: Traumas, medical surgical units, codes, mother/baby units Most patients had no Organized religion (60% of Spokane is non-church affiliated) Challenge in identifying where to place chaplain interventions in this format Challenge in identifying where to write their care plan

16 BTW Palliative Care Team Palliative Care Feedback: The Chaplain who wrote in a narrative format was asked by the Director of the Palliative Care team, to write using the HOPE format on at least 2 or 3 patients per day, or would be asked to leave the team.

17 CARE Format Chaplain Holly Gunby developed CARE (Concerns, Action, Resources, Evaluation/Effects on healthcare) What Worked: Palliative Care Team Feedback Writing about patient/family resources was valuable in work Chaplain Feedback Worked well for Trauma, codes, Emergency department, and when patient/family were in distress Appreciated documentation of Resources Appreciated documentation of Action

18 Barriers to this CARE format Palliative Care Team Feedback Would like more of a spiritual history and articulation of patient perceptions Chaplain Feedback Challenge identifying where to write spiritual history Uncertain how to proceed when there were no concerns identified Did not seem to apply to routine encounters and on mother/ baby unit

19 BTW Palliative Care Team Palliative Care Feedback: Chaplain using the narrative format noticed that the referrals were declining, and was being invited to no care conferences by the physicians Physician perception: no spiritual assessment was being done on the patients, because the chart note did not contain the same quality as the Chaplain using the format to chart.

20 Spiritual CARE Documentation Format

21 Example 1: Spiritual CARE Critical Information Patient states he was recently diagnosed with cancer. D. was very grateful for chaplain's visit as he describes himself as a man of faith. D. shared about instances in his life where he felt God revealed himself to him and how that has made his greatest purpose getting other to know and love God. He wonders what other people think when he talks about God and the different visions he has had of God. Action Chaplain explored patient's faith and offered a prayer. Resources D. seems to have his greatest hope and support in his faith in God. He wonders if God is going to come soon and save all those who are Christian. Evaluation Faith seems to be one of D.'s biggest concerns and joys- chaplain remains as a way to help promote patient's spirituality

22 Example 2: Spiritual CARE Critical info: Ref'd to pt RE a phone charger need, but pt stated she was feeling "anxious" and proceeded to share multiple concerns she has RE a daughter's illness, recent deaths, and her own illness trajectory and her care giving of others. Pt has a strong faith background and supportive friends. Pt is a musician and music teacher. Action: (1) Pastoral listening allowing patient to tell her story, (2) bearing witness to her faith story and her ability to both survive multiple losses and other challenges, affirming her journey which has had much struggle. (3) Pt and I prayed together. Resources: Pt relies on her faith and belief even when she does not "feel it"; she has good friends who she names as very supportive. She apparently has good relationships with her children but they are also having some problems and she plays a supportive and care giving role for them. Pt is very articulate and able to make meaning as she relates how she copes with her problems. Evaluation: Pt appeared more relaxed as a result of our conversation so pastoral dialogue/listening and prayer will likely help pt continue to identify and utilize her emotional and spiritual resources for her own healing, strength for the road ahead. Chaplains available per indicators or request.

23 What Worked in updated CARE format All 16 Chaplains charted using this format Palliative Care Team Feedback Patient-centered, able to easily find information about patient/ family MD, ARNP, RN, and SW were reading the Chaplain notes before seeing the patient/family Other Clinicians Feedback (unsolicited) RN, Physical Therapists, physicians, social workers, child life specialists, outside of the palliative care team commented: Reading Chaplain notes before entering patient room Appreciated the articulation of patient preferences/concerns and effects on health care

24 Conclusion Started with 5 of the 16 Chaplains meeting the quality measures consistently, now 14 of the 16 chaplains meet the quality measures consistently There was some additional time spent at first in documenting, but the chaplains are feeling more proficient now Notes are valued by this interdisciplinary team, and others

25 Recommendations Quality needs to remain a priority, and chart audits and education need to be on-going More study needs to be done outside this pilot group in order to evaluate CARE as a valuable format across hospital specialty areas according to the interdisciplinary team Continue to use and adapt the CARE format of documentation

26 References Anandarajah, Gowri, MD and Ellen Hight, MD, MPH. Spirituality and Medical Practice: Using HOPE Questions as a Practical Tool for Spiritual Assessment. American Family Physician Jan 1:63 (1): Lampe, Susan. Focus Charting: Documentation for Patient Centered Care 7 th ed. Minneapolis: Creative Healthcare Management, 1997.

27 Questions?