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Abstract
Background Unintended shocks from implantable cardioverter defibrillators (ICDs) are often distressing to patients and family members, particularly at the end of life. Unfortunately, a large proportion of ICDs remain active at the time of death among do not resuscitate (DNR) and comfort care patients.
Methods We designed standardised teaching sessions for providers and implemented a novel decision tool in the electronic medical record (EMR) to improve the frequency of discussions surrounding ICD deactivation over a 6-month period. The intended population was patients on inpatient medicine and cardiology services made DNR and/or comfort care. These rates were compared with retrospective data from 6 months prior to our interventions.
Results After our interventions, the rates of discussions regarding deactivation of ICDs improved from 50% to 93% in comfort care patients and from 32% to 70% in DNR patients. The rates of deactivated ICDs improved from 45% to 73% in comfort care patients and from 29% to 40% in DNR patients.
Conclusion Standardised education of healthcare providers and decision support tools and reminders in the EMR system are effective ways to increase awareness, discussion and deactivation of ICDs in comfort care and DNR patients.
- standards of care
- quality improvement
- patient preference
- patient-centred care
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Footnotes
DYC and MPW contributed equally.
Contributors DYC and MPW both contributed equally to this study. They were responsible for the design and execution of this study, writing of the study charter, submission of institutional review board exemption, creation and delivery of EMR and education sessions, data collection, data analysis, creation of figures, writing of the manuscript. BY was responsible for data collection and writing of parts of the manuscript. DPJ-K was responsible for statistical analysis after data completion. DCM was responsible for assisting the design of this study. DJC and JIL were principal investigators and were responsible for supervision and oversight of this project’s design and implementation and editing of this manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval According to institutional review board (IRB) policies at the authors' institution, this work met the criteria for quality improvement activities and was exempt from IRB review.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.