Adaptation of the Serious Illness Care Program to the hospital medical ward setting
| Component | Original in oncology clinic | Adaptation to hospital medical ward |
|---|---|---|
| Tools | Previsit letter | Script adjusted to reflect hospital setting rather than clinic visit |
| Serious Illness Conversation Guide | No changes | |
| Clinician Reference Guide | No changes | |
| Family communication guide | No changes | |
| Clinician training | 2.5-h workshop including reflection; didactic teaching skills practice involving role play using the Serious Illness Conversation Guide with standardized patients; and direct observation and feedback from expert faculty | No changes |
| System change | ||
| Patient identification | “No” response to question “Would you be surprised if this patient died in the next year?” | Leveraged an existing hospital initiative to screen all patients in the emergency department aged ≥ 65 yr at the time of admission with the interRAI Emergency Department Screener; patients with a score of 5 or 6 who had a stay of at least 48 h on the medical ward were eligible |
| Reminding clinicians | Email sent the day before the clinic visit notifying the clinician that the patient is due for a conversation about serious illness; on the day of the visit, the Serious Illness Conversation Guide is placed with the face sheet that is given to clinicians before each patient visit | Hired a unit champion (former bedside nurse from the medical ward), who reminded clinicians in person, by telephone or by text message to have a conversation about serious illness with eligible inpatients under their care |
| Patient preparation | Previsit letter mailed to eligible patients | Unit champion prepared patients/families in hospital using the script adapted from the previsit letter |
| Conversation using Serious Illness Conversation Guide | During outpatient visit in clinic room | During hospital stay, in a private meeting room on the ward |
| Documentation of conversation | Electronic medical record module using a structured format that aligns with the items in the Serious Illness Conversation Guide | Dictated, structured clinical note that aligned with the items in the Serious Illness Conversation Guide; the transcribed note was placed in the patient’s electronic medical record and automatically faxed to the patient’s primary care physician (e.g., using the same workflow as for consultation notes and discharge summaries) |
| Patient and family support | After the conversation, the clinician gives the patient the Family Communication Guide | After the conversation (typically 24–48 h), the unit champion gave patients/families the Family Communication Guide and also provided in-person support and debriefing |