Instiutionally Standardized Education Module and EMR Documentation for Death by Neurological Criteria Evaluation Can Improve Provider Compliance with Guidelines in a Tertiary Care Academic Medical Center (P3.218)

Objective: Institutional quality improvement initiative to standardize evaluation and documentation of death by neurological criteria with goals of improving compliance with guidelines Background: Our institute had several cases of conflict come to light in the understanding, evaluation and provider-family communication in the clinical scenario of patients being evaluated for death by neurological criteria (DNC, brain death). Provider understanding and awareness of clinical guidelines was found to be low across neurological and non-neurological sub-specialities. It was deemed important to follow appropriate procedures based on published guidelines and a standardized process to evaluate patients for DNC to provide appropriate care for each patient, optimize ICU resource utilization and strengthen provider and public trust. Due to medical, legal & ethical issues involved, an institutional standard was called for on the clinical evaluation & communication Methods: After seeking feedback from clinical providers from all sub-specialties about discrepancies in understanding and implementation of brain death procedures, we revised the institutional policy to reflect emphasis of educational gaps and reflect the latest published guidelines and practice updates. We created an education module,standardized template in electronic medical record incorporating a checklist, order set, intranet webpage and a tiered consult system to allow graded escalation in presence of conflict Results: The project led to increased participation and satisfaction amongst the clinical providers in the intensive care units when a patient was clinically suspected to be brain dead. The education toolkit empowered providers with an education source to evaluate patients with a consistent approach based on published practiced parameters.We observed a trend in decrease in length of stay and variance for brain dead patients since the toolkit was implemented in early 2013 Conclusions: A standard care pathway towards evaluation of patients with death by neurological criteria can be successfully implemented at institutional level Disclosure: Dr. Crumpler has nothing to disclose. Dr. McDonough has nothing to disclose. Dr. Tucker has nothing to disclose. Dr. Bowton has nothing to disclose. Dr. Datar has nothing to disclose. Dr. Brashear has received personal compensation for activities with Allergan, Ipsen, Revance and Concerta as a consultant. Dr. Brashear has received royalty payments from books royalties. Dr. Brashear has received research support from Ipsen, Merz, Allerg Dr. Sarwal has nothing to disclose.