Today, I am joined by Kei Ouchi to disucss rapid code status discussions in Emergency Medicine and Critical Care. I came across Kei after he put up an amazing post on ALIEM with his co-author Naomi George. Conversation is the essence of palliative care–we need to be experts at them.
Kei Ouchi, MD
Kei Ouchi is an assistant professor of emergency medicine at the Brigham and Women's Hospital in Boston. He splits his time between EM and palliative care research. [@KeiO97]
Kei's and Naomi George's Guide to Rapid Code Status Conversations
More to Read
- ALIEM Post
- Prognosis after intubation study by Kei
- Long-term prognosis after MV (Kei's new study)
- Functional trajectories of older adults after critical illness
- Worse than dying
- How patients experience LTACH
- Median survival is 8 months if older adults are transferred to LTACH
How Kei Trained in Palliative Care Conversations
Scott, I realized I’ve never told you anything about how I trained in palliative care communications skills. I keep a record of difficult communication cases from my practice, and I regularly hire actors/role play the encounters with Susan Block (mentor) to get coaching since 2014. She is a master communicator and has been teaching this internationally for the last 35 years. I also completed the following courses and now teach Vital Talk to our trainees with palliative care folks.
Vital Talk is adapted to EM by Corita Grudzen, who is now running a large, national study to see if this makes a difference in patient outcomes.
My ED code status conversation guide is an adaptation of the original Serious Illness Conversation Guide created by Susan Block:
Kei's Newest Article
Additional New Information
More on EMCrit
- EMCrit 285 – More on Palliative Care Conversations in Resuscitation(Opens in a new browser tab)
- EMCrit Podcast 25 – End of Life and Palliative Care in the ED(Opens in a new browser tab)
- Podcast 165 – The Semantics of End of Life Discussions with Ashley Shreves(Opens in a new browser tab)
Additional Resources
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Really enjoyed this conversation. As an ED RN I’ve often wondered how I could better support discussions and decision making around end-of-life care..particularly when dealing with family in times of crisis. It seems appropriate that nurses, who spend a great deal of times at the bedside, are also able to initiate discussions of values and expressed wishes. When the physician comes to have the “goals of care” discussion, the patient/family has already had some time to reflect on their values/wishes without feeling “put on the spot” ..and perhaps the team has some insight in to how to better “align” themselves… Read more »
As a UK intensivist I see this as an established part of what we do. We have limited resource and commencing overly burdensome therapies on individuals when it’s not what they would want or survival with an acceptable level of function is unlikely Is not ethically acceptable for the individual or society as a whole. A movement in the UK titled “realistic medicine” crystallises this and is making it not just an acceptable part of our practice but a standard of care. My only comments to the otherwise excellent conversation guide are: Allow a deliberate time for silence after the… Read more »
yes!!
Dr.Weingart commented on religious views of resuscitation. Christians view life as intrinsically valuable because humans are created in the image of God. We know we are always in God’s hands and if we do our best and die,we are ok with that. Many people today view suffering as the worst evil.Christians have generally viewed suffering as a means that can be used by God to make us better-more patient, more humble, and more like Jesus who suffered for us. So Christians may choose more aggressive treatment than others, and deal with the suffering, in order to respect life- even life… Read more »
Thank you for this podcast, I just listened to it today. I feel fairly comfortable with palliative discussions in the ER but something I wanted to inquire of Kei or whomever is what do you do when the family member (inevitably) asks you what you would do if this was your family member? Do you answer truthfully? Do you defer or demur? I sometimes will answer honestly (especially since I have had a tough and relevant situation in my life) but also sometimes defer since I fear that I am imposing my own values rather than the patient’s.
As a personal practice, I usually answer this with “Tell me about your [mother].” Sometimes the spirit of the question is seeking permission for an answer they already are inclined towards. By giving them space to open up even more (e.g. how quality of life has changed, how they valued their independence or prior functional status, etc.), I may learn where their heart is at, and make a more patient/family-focused recommendation. It is inevitable that we bring our own values and experiences into these conversations, but I strongly agree with your sense of caution in your final sentence that we… Read more »