“Honoring Choices” is the title of a Community Life quality improvement program that addressed a vexing problem that they encountered over and over again. The program’s success was recognized by The Fine Foundation, Jewish Healthcare Foundation and the Pittsburgh Regional Health Initiative with a bronze award at the recent Fine Award for Teamwork Excellence in Care at the End-of-Life.
“Honoring Choices” was about Community Life trying to get to the bottom of this problem and set it right. What they discovered was that the loop of communication wasn't closing - the patients may have stated their wishes, and the Community Life physicians may have heard them and recorded them, but when a patient got sick after hours or a family member became acutely concerned about their health, they went to the emergency room. Once there, a series of physicians (emergency, "moonlighter" admitting patients to the hospital, hospitalist attending and occasionally even an intensivist) who were not around the table when that compact was made were making decisions, without benefit of knowing the "plan." The acute episode wasn't usually discussed by Community Life staff until the next morning, by which time the wheels were often turning in the hospital - often without anyone communicating with the Community Life physician about it first. At discharge, the instructions given to the patient and family often didn't make it into the hands of Community Life staff - setting up the patient to "bounce back" (to the hospital, not to their previous state of vigor).