Ochsner Medical Center Description

We utilized a bereavement survey instrument to evaluate family satisfaction with end of life care for all patients who died at Ochsner Medical Center (OMC) before and during implementation of the palliative care (PC) consultative service.

Goal

To increase bereavement satisfaction scores by 10% above pre-PC scores within 12 months of implementation of the consult service.

Measures

The 40 question bereavement survey is divided into the following 7 measurement sections:

• Time of Death
• Visitors and Family
• Physician
• Nursing
• Personal Issues
• Room
• Overall Assessment

Data Collected

The palliative care committee, in consultation with Press Ganey, developed a 40-question bereavement survey to assess family satisfaction with end of life care provided to patients who died at our facility. Each questionnaire is addressed "to the family of" any patient who dies at OMC including adults, pediatrics, and newborns. Surveys are mailed by Press Ganey 6-10 weeks after the patient's death. Each quarter Press Ganey analyzes broad measures of patient care and specific questions that include top box analysis (how patients score each question) and priority index. All bereavement surveys are then sent to the OMC palliative care department for review of specific comments. Regardless of expressed satisfaction level, all completed surveys with a name/address provided are sent to Patient Relations for telephone follow-up.

Summary of Results / What Worked and Why

Before implementation of the PC consult service, baseline survey score data collection was conducted on families who returned surveys between December 2005 and March 2006. The PC service began seeing inpatient consults March 2006 and routine surveying was resumed in June 2006. Scores from the Press Ganey reports represent the bereavement satisfaction outcomes of all hospital-based deceased patients including some patients who received PC services during their hospitalization. The return rate for the bereavement survey is 17% of all deaths. Similarly, the return rate for the standard inpatient satisfaction survey is 23% of all discharges. The overall bereavement survey score pre-PC was 76.7. The overall survey score improved to 89.7 by April 2007. We also demonstrated improved satisfaction with patient care measures before and after implementation of PC. The following lessons were learned during this process:

• Support of institutional leadership is critical to successful implementation of a bereavement survey. To demonstrate OMC's commitment to EOL care, the CEO and COO were personally involved in formulating the survey's cover letter.
• A Palliative Care-enriched environment improves bereavement scores. Institutional acceptance of palliative care can be accomplished through direct patient care, role modeling, and educational efforts.
• Visitation hours and visitor accommodations greatly influence family satisfaction with EOL care.
• Difficulty in obtaining an appropriately completed death certificate often leaves a lasting impression on family members.
• In response to survey results, Bereavement Resource Booklet/Gift was created and implemented which is provided by the hospital chaplain to family members of each patient who dies at OMC prior to their departure.
• We created an "End of Life Symbol" for actively dying patients to increase staff awareness and foster patient privacy and dignity.

Challenges

• Extensive effort was required to establish consensus in order to overcome institutional reluctance to surveying family members of deceased patients
• Challenges concerning Information Systems logistics of ensuring appropriate patient population including the capturing of accurate information for mailing to family members
• Modified, shortened, and clarified the Cover letters / envelopes to read: "To the Family of. . ."
• Pre-palliative care baseline survey comments concerning mail out during holiday season lead to revision of cover letter
• Confusion caused by Press Ganey printing error identifying other hospital system in the comments section of Ochsner survey
• Low nursing unit "N" creates difficulty in utilizing survey scores and comments to effect positive change in a timely manner