1. Barriers to Quality End of Life Care in the ICU – Results of a Multicenter Survey Todd Sarge MD 1 ; Sharon O’Donoghue RN MS CNS 1 ; Lynn Mackinson RN MS 1 ; Ariel Mueller MA 1 ; Priscilla Gazarian RN PhD 2 ; Lisa Lehmann MD PhD 2 ; Kathleen Turner RN 3 ; Wendy Anderson MD MS 3 ; Sarah Beesley MD 4 ; Samuel Brown MD MS 4 1 Beth Israel Deaconess Medical Center, Boston MA; 2 Brigham & Women’s Hospital, Boston MA; 3 University of California, San Francisco CA; 4 Intermountain Medical Center, Murray UT BACKGROUND  In the US, approximately 20% of patients die during or shortly after an ICU stay.  End of Life (EOL) care practices can vary widely between hospitals and may often be inconsistent with patient preferences, values or goals.  Our goal was to survey ICU health care workers (HCWs) to determine the education, knowledge and perceived barriers to providing high-quality EOL care. RESULTS METHODS  We conducted a multicenter survey of ICU HCWs at 4 academic medical centers across the US (Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, University of California San Francisco, Intermountain Medical Center).  All physicians, nurses, respiratory therapists and social workers working in any of the participating ICU's during a two-week study period were eligible and invited to participate in the study.  A total of 440 HCWs responded (62% nurses, 24% physicians, 11% respiratory therapists and 3% social workers).

2. RESULTS Cont’d All Barriers Surveyed Barriers to Quality End of Life Care in the ICU – Results of a Multicenter Survey Todd Sarge MD 1 ; Sharon O’Donoghue RN MS CNS 1 ; Lynn Mackinson RN MS 1 ; Ariel Mueller MA 1 ; Priscilla Gazarian RN PhD 2 ; Lisa Lehmann MD PhD 2 ; Kathleen Turner RN 3 ; Wendy Anderson MD MS 3 ; Sarah Beesley MD 4 ; Samuel Brown MD MS 4 1 Beth Israel Deaconess Medical Center, Boston MA; 2 Brigham & Women’s Hospital, Boston MA; 3 University of California, San Francisco CA; 4 Intermountain Medical Center, Murray UT  Overall, 35% of respondents reported receiving EOL education; however, this varied widely among centers ranging from 22% to 68%.  The majority of HCWs (57%) were unaware EOL guidelines existed at their institution. 1 EOL Education RESULTS Cont’d  HCW perceptions of barriers to providing high quality EOL care were predominantly centered around the clinician - patient/family interactions rather than symptom management. CLICK TO ENLARGE FIGURE CLICK TO ENLARGE FIGURE CLICK TO ENLARGE FIGURE

3. RESULTS Cont’d Barriers to Quality End of Life Care in the ICU – Results of a Multicenter Survey Todd Sarge MD 1 ; Sharon O’Donoghue RN MS CNS 1 ; Lynn Mackinson RN MS 1 ; Ariel Mueller MA 1 ; Priscilla Gazarian RN PhD 2 ; Lisa Lehmann MD PhD 2 ; Kathleen Turner RN 3 ; Wendy Anderson MD MS 3 ; Sarah Beesley MD 4 ; Samuel Brown MD MS 4 1 Beth Israel Deaconess Medical Center, Boston MA; 2 Brigham & Women’s Hospital, Boston MA; 3 University of California, San Francisco CA; 4 Intermountain Medical Center, Murray UT  There is an ongoing need for quality improvement and education around EOL care in the ICU setting.  Future work should focus on improving and ensuring early clinician - patient/family discussions on goals of care, improving education for ICU HCWs on quality EOL care with specific emphasis on institution specific guidelines, and developing quality assurance metrics to track adherence to guidelines as well as patient/family satisfaction. CONCLUSIONS NEXT STEPS ACKNOWLEDGEMENTS Highest Rated Barriers This study was supported by the Gordon and Betty Moore Foundation. Statistical support was provided by the Center for Anesthesia Research Excellence (CARE) at Beth Israel Deaconess Medical Center.  Design and Test a comprehensive Bundle for EOL Care  Focus on patients not process  Humanize dying  Bring education to the bedside  Getting ourselves “conversation ready” in the ICU  Learn from success (UCSF)  Measure what we do  Incorporate EOL care into QI measures  The highest rated barriers identified included: 1) Differing expectations or understanding of prognosis between the patient's family and clinicians; 2) Differing expectation or understanding of the prognosis among family members; 3) The patient's wishes or values are unknown or not documented; 4) Under-utilization of palliative care services. CLICK TO ENLARGE FIGURE

4. EOL Education and Awareness

5. All Barriers Surveyed

6. Highest Rated Barriers