Caseworker Cultural Mediator Involvement in Neurocritical Care for Patients and Families With Non-English Language Preference: A Quality Improvement Project.
Autor: | Lele AV; Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA.; Neurological Surgery, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA., Brooks A; Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA., Miyagawa LA; Interpreter Services, Harborview Medical Center, Seattle, USA., Tesfalem A; Interpreter Services, Harborview Medical Center, Seattle, USA., Lundgren K; Interpreter Services, Harborview Medical Center, Seattle, USA., Cano RE; Interpreter Services, Harborview Medical Center, Seattle, USA., Ferro-Gonzalez N; Interpreter Services, Harborview Medical Center, Seattle, USA., Wongelemegist Y; Interpreter Services, Harborview Medical Center, Seattle, USA., Abdullahi A; Interpreter Services, Harborview Medical Center, Seattle, USA., Christianson JT; Interpreter Services, Harborview Medical Center, Seattle, USA., Huong JS; Interpreter Services, Harborview Medical Center, Seattle, USA., Nash PL; Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA., Wang WY; Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA., Fong CT; Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA., Theard MA; Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA., Wahlster S; Neurology, Harborview Medical Center, University of Washington, Seattle, USA.; Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, Seattle, USA.; Neurological Surgery, Harborview Medical Center, University of Washington, Seattle, USA., Jannotta GE; Neurocritical Care Service, Harborview Medical Center, University of Washington, Seattle, USA., Vavilala MS; Anesthesiology and Pain Medicine, Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, Seattle, USA. |
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Jazyk: | angličtina |
Zdroj: | Cureus [Cureus] 2023 Apr 17; Vol. 15 (4), pp. e37687. Date of Electronic Publication: 2023 Apr 17 (Print Publication: 2023). |
DOI: | 10.7759/cureus.37687 |
Abstrakt: | Objective To describe Harborview Medical Center's experience with the involvement of caseworker cultural mediators (CCM) for patients requiring neurocritical care. Methods Using univariate and multivariate analysis (model adjusted for age, Glasgow Coma Scale score (GCS), Sequential Organ Failure Assessment (SOFA) Scores, mechanical ventilation, transition to comfort measures only (CMO), and death by neurologic criteria), we examined CCM team members' involvement in the care of Amharic/Cambodian/Khmer/Somali/Spanish/Vietnamese patients admitted to our neurocritical care service between 2014-2022, factors associated with CCM utilization, and changes in CCM utilization after a QI initiative was implemented in 2020 to encourage healthcare providers to consult the CCM team. Results Compared to eligible patients (n=827) who did not receive CCM referral, patients with CCM involvement (n=121) were younger (49 [interquartile range, IQR 38,63] vs. 56 [IQR 42,68] years, p = 0.002), had greater illness severity (admission GCS 8.5 [IQR 3,14] vs. 14 [IQR 7,15], p < 0.001, SOFA scores (5 [IQR 2,8] vs. 4 [IQR2,6], p = 0.007), and more frequently required mechanical ventilation (67% vs. 40%, odds ratio, OR 3.07, 95% CI 2.06,4.64), with higher all-cause mortality (20% vs. 12%, RR 1.83, 95% CI 1.09, 2.95), and with a higher rate of transition to CMO (11.6% vs. 6.2%, OR 2.00, 95% CI 1.03;3.66). The CCM QI initiative was independently associated with increased CCM involvement (aOR 4.22, 95% CI [2.32;7.66]). Overall, 4/10 attempts made by CCMs to reach out to the family to provide support were declined by the family. CCMs reported providing cultural/emotional support (n=96, 79%), end-of-life counseling (n=16, 13%), conflict mediation (n=15, 12.4%), and facilitating goals of care meetings (n=4, 3.3%). Conclusions Among eligible patients, CCM consultations appeared to occur in patients with higher disease severity. Our QI initiative increased CCM involvement. Competing Interests: The authors have declared financial relationships, which are detailed in the next section. (Copyright © 2023, Lele et al.) |
Databáze: | MEDLINE |
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