Becker's Clinical Quality & Infection Control

17 PATIENT EXPERIENCE End-of-life discussions with nonmedical workers boost patient satisfaction, study finds By Megan Knowles A dvanced cancer patients who reg- ularly talked about their care goals with a trained nonclinical worker were more likely to report higher satisfac- tion levels and discuss their preferences with physicians, Stanford (Calif.) University School of Medicine researchers report in JAMA Oncology. e researchers tracked patients at the Veterans Affairs Palo Alto (Calif.) Health Care System for 15 months after they received a stage 3 or 4 cancer diagnosis or were diagnosed with recurrent cancer. Half of the 213 patients were randomly assigned to discuss care goals with a lay health worker for six months. e findings suggest patients were more at ease with their care decisions and more likely to talk about their care preferences with providers when they discussed their preferences with a lay health worker soon aer their diagnosis, said lead study author Manali Patel, MD, a medical oncologist and asssistant professor of medicine at the Palo Alto Veterans Affairs Health Care System. e lay health worker participated in an 80-hour online seminar and four weeks of observational training with the hospital's palliative care team. e worker guided patients through a program that addressed questions about their care preferences, in- cluding what their understanding of cancer was and how they would want to spend their time if they got sicker. ey also created care preferences, identified a surrogate deci- sion-maker and filed an advance directive. Patients who talked with the lay health worker were more likely to have end-of-life care preferences documented in their EHRs within six months of beginning the conver- sations — 92 percent of patients compared to 18 percent in the control group. e re- search team used EHR documentation to determine whether patients discussed these preferences with their physicians. e patients assigned to a lay health worker also said their oncology care was better, giving it an average satisfaction score of 9.16 out of 10, compared to the average of 7.83 in the control group. "is indicates that patients in the interven- tion were having a better experience with their providers despite having been prompted and activated to discuss really difficult topics," Dr. Patel said. "is is consistent with what other studies have shown, indicating that pa- tients value honest and open communication regarding their prognosis." n How a nurse-led initiative helps New York hospital patients sleep better By Megan Knowles A fter receiving concerns about how noise negative- ly affected patient sleep and staff stress levels, nurses from Manhasset, N.Y.-based North Shore University Hospital created an ini- tiative to reduce noise levels in the hospital's neurosurgical intensive care unit — and small changes led to lower noise levels, a study pub- lished in Critical Care Nurse found. Here are five things to know: 1. By adjusting the times for noisy activities, the unit reduced noise levels and maintained quiet times, seeing reductions in peak noise events six months after changes were implemented. 2. The unit's staff used a decibel meter to measure noise levels on the left and right sides of the nurs- es' station, which many providers share. They also measured noise in front of two patient rooms near the nurses' station, one of which is near the unit's primary entrance. 3. The researchers collected data for eight days before staff received education on the initiative and six months after quiet time was imple- mented. The baseline results were shared with staff after the initial data was collected. 4. The unit then launched quiet time periods twice daily, from 3 to 5 a.m. and from 3 to 5 p.m. Lights were dimmed, whispering was encour- aged and environmental noise was eliminated as much as possible during these designated quiet times. 5. The quiet times decreased peak noise levels after six months. The initiative also identified areas of im- provement, such as installing push- plate automatic opening functions at the unit's rear entrance for easier emergency department and operat- ing room team access and finding a different time/space for physicians to hold teaching sessions. n "Patients value honest and open communication regarding their prognosis." -Manali Patel, MD, asssistant professor of medicine at Palo Alto Veterans Affairs Health Care System

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