Dancing the WOLST: A Quality Improvement Project on Withdrawal of Life Sustaining Therapies (WOLST) (SA511C)

•Design a systematic approach to the WOLST process.•Integrate the systematic approach to WOLST into the EMR.•Maximize interdisciplinary team communication during a WOLST procedure. Literature demonstrates many patients with life threatening complex chronic conditions die in the intensive care unit (ICU), with nearly half of these patients dying after withdrawal or withholding of life sustaining therapies.1-7 There is considerable variation in how WOLST occurs and whether formal training is provided.2 No prior research has established the best practices for this procedure.1-7 In patients undergoing WOLST, we will use a best practice guideline and electronic medical record (EMR) templated note to increase provider confidence and quality of death by 10% in 12 months. We created a best practice WOLST guideline through literature review and expert consensus. This guideline included a pre-WOLST huddle template and a templated EMR note. Care team members involved in a WOLST received a survey to assess their confidence with the process and evaluate their perception of quality of death in their patient. Participants included clinicians involved in a patient’s WOLST. The setting included all ICUs at a quaternary children’s hospital. Baseline data was collected following 35 WOLST procedures, 250 surveys were sent with 116 responses, resulting in a survey response rate of 46%. Physicians and nurses reported a mean score of 84 and 82 out of 100 respectively for confidence in preparing families for the dying process. Data revealed marked variability when evaluating clinicians perception of death, with scores ranging 0-100; mean=81. Thematic analysis identified key processes on which to focus PDSA cycles including: anticipatory guidance to team and family, provider role clarity, and earlier involvement of interdisciplinary team members. Little has been published regarding a specific methodology for teaching the process of WOLST to care teams, thus development of a systematic approach is critical to providing the best care at the end of life. Identifying key drivers to WOLST procedures has enabled creation of a practice guideline and EMR template for continued PDSA cycles.