PM2020: Making the Most out of the WOLST

Purpose/Objectives:

Purpose: Withdrawal of Life Sustaining Therapies (WOLST) is a critical hospital procedure that occurs in ~40% of children who die in hospital ICU settings. A WOLST best practice guideline (BPG) and EMR note template were created at a quaternary children’s hospital to standardize the WOLST process through the promotion of a pre-WOLST interdisciplinary team huddle.

Objectives: We aimed to increase use of the BPG and EMR note template by 25% within 12 months. We also aimed to improve provider perception of the WOLST process by 10% in 12 months.

Design/Methods: Methods: A 21 question mixed-methods survey was created to assess staff perception of WOLST at a single quaternary children’s hospital. Respondents were asked about use of the hospital best practice resource guide and EMR note template, and rate perception of patient care, communication, staff distress. Starting in December 2021, patients who underwent WOLST were periodically identified from in-hospital deaths. Surveys were sent to each person who documented a note in the EMR in the last 2 days of life for each patient who underwent WOLST. Initial survey results were analyzed for PDSA cycle interventions. Data collection for this project is ongoing. Metrics: Outcome measure: Number of documented template notes and respondents who reported using the best practice guide. Process Measure: Likert scales were used to score provider perception of the WOLST process. Balance measure: Narrative responses were used to identify concerns related to the intervention and areas for future intervention.

Results:

Results: Between 12/20/21 and 3/7/22, a total of 401 surveys were sent from 25 patient charts. 149 surveys were completed for a response rate of 37%. Of the 25 patients, 9 (36%) had WOLST plans documented using the EMR note template. 47% said the resources were not applicable for their role. 90% of the remaining respondents did not use the resources due to not knowing or forgetting about it. 92% of the respondents who used the resources found them helpful. Only one respondent did not use the resources due to them not being helpful. The resources in place were updated based on current evidence and hospital practice. Meetings were held with stakeholders in the CVICU, PICU, and NICU to re-educate providers and staff on the availability of the WOLST resources. Post-intervention surveys are being collected.

Conclusion/Discussion:

Discussion: Analysis of future survey responses will determine if the established resources are helpful for staff during the WOLST procedure. Further PDSA cycles will be needed to further optimize the WOLST process. Narrative responses from survey results will be helpful in identifying future areas of intervention and numerically scaled responses of staff perception will help determine if improvement is made. Standardization of the WOLST procedure across hospital units may be helpful to minimize staff distress.