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And importantly, our socialworker, Aunt Kelly, actually does a search and I would say 75% of the time she finds somebody maybe even higher than that, finds somebody who’s actually a surrogate. Let’s say they’re in the ICU now on a ventilator. To have a socialworker who’s dedicated in many places.
Missouri set a very high bar, explicit written documentation that applies to this specific circumstance, which the Cruzan’s eventually cleared. But legislation can change, clinical practice can change, but I think what we’ll talk about today is how we’re now opening the door to conversations rather than legal rules and documents.
What we did was ask clinicians earlier in the ICU stay for very sick patients to document prognosis, and for those who they thought would survive, to document six-month functional prognosis. And that helped them focus on that instead of, say, the blood pressure, the vasopressors or the ventilator settings that day. Eric: Okay.
It used to also be a socialworker and myself who would actually go to clinic and spend some time up there. Said socialworker has left since then, so it’s now just me. And I will document everything they express to me in a obviously non encephalopathic state. Sarah 06:23 It’s just me.
So whether or not somebody wants to be on CPR or ventilator, that sort of thing. What that looks like, to some degree, by having a conversation, by documenting wishes, we can potentially influence what that looks like and what that experience is for that person who is dying and then also for family members who are left behind.
Alice has stated that she is unsure about a feeding tube but is certain she does not want a ventilator or other assistive breathing device. Do your socialworkers know how to access the lending closet for specialized equipment? Her grandso n was able to receive support from the socialworker and the child life specialist.
And yet, I think for everyone who’s elderly, which is anyone who’s my age or older, I would say it’s very important and ought to be part of an annual exam that we ought to be asking that, and documenting it in the chart. I think Bob also noted documenting it. Eric: Anybody else’s thoughts on that? Who are they?
Whether it’s the consult rate or documentation of a conversation, hospice referrals, those kinds of things, and then patient outcomes, quality of life, symptom burden. You’re not hiring a bunch of socialworkers or nurses or docs to do it. But what I shared is the paradigm of research has gone a little backwards.
It has been well documented that during a disaster the bulk (and often, the most critically injured) of patients will arrive by their own means and not by ambulance, and that is exactly what happened. We had no idea what was going to happen next and we were all dreading the arrival of more seriously burned people.
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