Inpatient FAQ

The Jumpstart Program is a quality improvement program using one-page “Jumpstart” guides to increase the occurrence and quality of goals-of-care discussions between clinicians and patients with chronic, life-limiting illness. We are evaluating the Jumpstart Guide in a series of randomized trials. The current study is funded by the National Institute of Aging.

Goals-of-care discussions are defined as ‘planning for medical care that may happen in the future if the patient becomes sicker.’ The conversation normally occurs between a clinician and the patient and/or the patient’s surrogate decision-maker to identify the patient’s values and goals and the overarching aims of medical care for the patient. These discussions can include decisions about using or limiting certain medical interventions, worsening of disease, or end-of-life care.

Harborview, UW Medical Center–Montlake and UW Medical Center – Northwest.

Dr. Susan Merel conducts a series of educational programs on goals-of-care discussions and has also created a handout with guidance on starting these conversations: Goals of Care Conversations: Why, When, How.

You may reach the study PI, Dr. Randy Curtis, at (206) 744-3356 or <jrc@uw.edu> or you may contact one of the research coordinators: Joanna Heywood, (206) 537-6246, <heywood@uw.edu> and Nicole Leduc (206) 581-9622, <ncleduc@uw.edu>. If you have questions or concerns about a specific patient, you may also respond directly to the Jumpstart Guide email.

Potentially eligible patients are identified by research coordinators through review of the electronic health record. Clinicians will be informed via secure chat or page of the research coordinator’s intention to approach the patient. If the patient is not a good candidate, the clinician may return the secure chat or page and request the study team not approach the patient.

If not contacted by the clinician within the first 1-2 hours after the secure chat or page, the research coordinator will attempt to recruit the patient or their surrogate decision-maker. If enrolled, the patient or their surrogate in one trial arm will receive a personalized Jumpstart Guide along with members of their care team. In a second trial arm, patients and surrogates will NOT receive a Jumpstart Guide, but their care team will receive a Jumpstart Guide. The third arm receives usual care with no Jumpstart Guides.  The goal of the Jumpstart Guide is to encourage a goals-of-care discussion when appropriate as well as the documentation of the discussion in the electronic health record in the usual way.

Hospitalized patients age 55+ years with chronic, life-limiting illness OR hospitalized patients 80+ years.

A research coordinator who has reviewed your patient’s electronic health record.

Clinicians will be emailed and hand-delivered Jumpstart Guides. Jumpstart Guides are not available in the patient’s chart at this time.

We use automated methods to determine whether these documents exist within the EHR.  You can find them in Epic under the patient’s demographics, where there are tabs for both Advance Directives (POLST and DPOA-HC are included here) and Code Status.

Document the conversation in the electronic health record as you normally would- no need to follow-up with the study team. Consider including a few of the patient’s or surrogate’s words in your documentation.

No! Pick the topics you feel are best suited for this patient.

The patient or their surrogate has already provided written consent to the study team if you are receiving a Jumpstart Guide.

We are comparing two types of Jumpstart Guides and usual care.  The first Jumpstart uses only information from the electronic health record and will be easier to implement.  The second Jumpstart uses information from a survey completed by the patient or family and will be harder to implement, but may provide more information.

If the patient or their surrogate receives a copy of the Jumpstart, they’ve been enrolled into the arm of the study that uses this survey-based Jumpstart. If a patient didn’t receive a Jumpstart but you did, then they were enrolled into the EHR-based Jumpstart or usual care arm of the study.

The research team will always send a secure chat or page the attending or primary contact prior to approaching the patient. If you don’t think it is appropriate to approach your patient, please secure chat or call us back to let us know.

If you can still fit in a goals-of-care conversation, that’d be great! Otherwise, we understand sometimes there just isn’t enough time.

We know clinicians can be very busy, but we hope you’ll be able to make time for a short goals-of-care conversation.

Feel free to forward the Jumpstart along to the new primary team and let them know our Jumpstart Program is recommending the patient be considered for goals-of-care.

Yes! Feel free to share the Jumpstart Guide with any clinicians who would be appropriate for having a goals-of-care discussion with the patient. Clinician recipients of the Jumpstart vary based on service, but we typically include the primary contact and attending and, if applicable, resident, fellow, or advance practice provider (APP).

We understand sometimes goals-of-care discussions may be more appropriate for the patient to have with their primary doctor, but still encourage you (as a hospital clinician) to consider if the patient could benefit from a goals-of-care discussions while hospitalized.

We leave this decision up to you (the clinician). If geriatrics or palliative care is consulting but hasn’t yet visited the patient, we’ll include them in delivery of the Jumpstart along with the primary team. Usually only one of the Jumpstart recipients needs to have the goals-of-care discussions with the patient.

Yes!

 Clinician recipients of the Jumpstart vary based on service, but we typically include the primary contact and attending, and if applicable, resident, fellow, or advance practice provider (APP).

 We encourage all current members of the care team to consider if the patient is appropriate for having a goals-of-care conversation. As the daytime covering resident, you may have this conversation with the patient or you may share the Jumpstart information with the regular primary team.

If you feel you received the Jumpstart Guide in error, please let the study team know by either returning the secure chat, calling us, or responding to the Jumpstart Guide email.

No. If you feel it is inappropriate to have goals-of-care with your patient at this time or you are unable to have goals-of-care for some other reason, that is ok.  We understand that these discussions aren’t always appropriate or possible.

 Yes!

For our current study, we will not enroll patients who are not able to provide consent and who have no available family or surrogate decision-maker. If we contact you about a potentially eligible patient who is not decisional capable and does not have an available family or surrogate decision-maker, we would appreciate it if you would let us know by secure chat, phone, or email.

Yes! The Jumpstart program is promoting early goals-of-care discussions for patients with chronic illness, even if they are relatively healthy.

 Discussing code status is a great start! We encourage you to further explore other components of goals-of-care, such as discussing the patient’s values and goals, assessing health states or treatments the patient would not find acceptable, and – when appropriate – helping the patient fill out a durable attorney for healthcare or a POLST.

 Often, yes! Prompting goals-of-care conversations is not only about code status, but also about the treatments that are best aligned with the patient’s values and goals.  You may also discuss with the patient acceptable health states and treatments, and – when appropriate – help the patient fill out a durable attorney for healthcare or a POLST.

While the acute condition may be the most pressing concern, we still encourage you to consider starting an early goals-of-care conversation with your patient.

 That’s great! We try to exclude patients from the study who have already had goals-of-care discussions, but sometimes we miss these conversations. Make sure to document your goals-of-care discussions in the electronic health record.

 We encourage you (as a hospital clinician) to consider if the patient would benefit from a goals-of-care discussions while still in the hospital.