Table 1:

Adaptation of the Serious Illness Care Program to the hospital medical ward setting

ComponentOriginal in oncology clinicAdaptation to hospital medical ward
ToolsPrevisit letterScript adjusted to reflect hospital setting rather than clinic visit
Serious Illness Conversation GuideNo changes
Clinician Reference GuideNo changes
Family communication guideNo changes
Clinician training2.5-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 facultyNo 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 cliniciansEmail 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 visitHired 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 preparationPrevisit letter mailed to eligible patientsUnit champion prepared patients/families in hospital using the script adapted from the previsit letter
Conversation using Serious Illness Conversation GuideDuring outpatient visit in clinic roomDuring hospital stay, in a private meeting room on the ward
Documentation of conversationElectronic medical record module using a structured format that aligns with the items in the Serious Illness Conversation GuideDictated, 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 supportAfter the conversation, the clinician gives the patient the Family Communication GuideAfter the conversation (typically 24–48 h), the unit champion gave patients/families the Family Communication Guide and also provided in-person support and debriefing