Abstract
Dear Editor:
A-SURF is a tool used by the interdisciplinary palliative care team to rapidly respond to new requests for consultations. With A-SURF, all disciplines can quickly and consistently glean necessary elements from brief chart review, discussion with the patient's nurse, or conversation with the patient or family, leading to rapid assessment and initiation of individualized care.
Team members use A-SURF to rapidly assess patient needs, then disseminate the information to the team by secure texts. Family meetings, if appropriate, are scheduled at standard times—9:30, 11, 1:30, and 3. Medical providers alert the team if the initial consultation has been completed. Nonmedical team members document expectations for completing the consultation. (“Patient is comatose. Family unavailable today. Full consult to follow discussion with family.”)
An Actual Case
Before A-SURF
The palliative care physician is contacted on a busy day about an elderly woman with a massive stroke, comatose, intubated in the field, who reportedly did not want life support in the face of nonrecoverable injury. Palliative care assistance is requested to discuss compassionate extubation. The bedside nurse reports that family will arrive in the afternoon, so the palliative physician and social worker return at 3:30 p.m. They find limited family members present, so arrangements are made for another meeting. Full family meeting and extubation occur the following day.
After A-SURF
The palliative care social worker notes a new consult and goes to the ICU to review. She finds an elderly woman with a massive stroke who reportedly did not want life support in the face of nonrecoverable injury. She contacts family members, who are identified health care surrogates, to schedule a meeting and discovers the patient was the caregiver for her grandson who will be expecting her at the bus stop. With family permission, the social worker contacts the school and makes arrangements for the child's support. The family gathers for a meeting, discussion, and extubation that same afternoon.
Combined with standardized meeting times and deliberate team communication, A-SURF has enhanced efficiency and effectiveness, decreased team anxiety, and improved patient care. Nonmedical providers have increased confidence and responsibility in making first contact. Patients receive earlier social and spiritual support. Medical team members have more information prior to completing consults. We feel this tool can have benefits similar to other interdisciplinary palliative care teams regardless of the disciplines represented on the team.