Dr. Mirna Mohanraj of the Mount Sinai Health System developed a program to collect more information about patients in intensive care units. She talks about the work and the benefits for doctors, patients, and families.
Patients in a hospital’s intensive care unit aren’t just struggling with their disease or their injuries.
They are experiencing a profound loss of autonomy. Some may be conscious but unable to communicate. Mirna Mohanraj, MD, says it’s easy for doctors and care teams to lose sight of the humanity of those patients.
Mohanraj, an associate professor of medicine at the Icahn School of Medicine at Mount Sinai, helped develop a new program to think about ICU patients differently. With the program, clinicians gain biographical information of the patients to help them be seen as individuals with rich, meaningful lives. She says the program is designed to aid patients and to foster a deeper relationship between doctors and patients.
The program was initially launched at Mount Sinai Morningside in New York City and has since been launched at other ICUs in the system. The Physicians Foundation gave Mohanraj the Medical Innovator Award for her work on the program.
Mohanraj says she’s heartened by the early results of the program.
“Many of the positive qualities that make a person a person, are taken away from them, and they lose control of their ability to sort of control their own narrative,” she says.
Mohanraj says the work “is really centering on ICU patients who cannot advocate for themselves, who cannot speak for themselves, and really aiming to promote engagement between the healthcare providers, especially the physicians, with their patients, and then also, hopefully having the positive impact of increasing fulfillment from work for our healthcare professionals.”
In an interview with Chief Healthcare Executive®, Mohanrah shares the experiences and lessons learned from the program, the value for physicians, and how it can be replicated elsewhere. (See part of our conversation in this video. The story continues below.)
‘Not treating a disease’
Mohanraj, who serves as vice chair of DEI in Mount Sinai’s Department of Medicine, says she’s seen the need to focus on the humanity of patients as an intensivist.
“We have a very high workload,” she says. “We have patients who cannot communicate with us. Our providers are coming to us, to their training programs, already burned out, and all of those things contribute to disengagement, and all of those things lead to our ICU patients being at very high risk for dehumanization.”
The pilot program was conceived before the emergence of COVID-19, but the pandemic highlighted the challenges, when patients were more isolated and clinicians spent less time in the room.
With the program, a whiteboard is placed in the patient’s room, and it lists important people in their lives and can include photos.
Mohanraj and her team developed a list of 10 questions to get information about their patients to gain insights into their background.
When the biographical information is filled out, it’s read during rounds, and Mohanraj calls that “a pause moment.”
“It is a pause for us to remember that we are not treating a disease,” Mohanraj says. “We are not treating a room number. We are treating a human being with a life story, and they are under our care as a human being with a life story.”
Some of the questions are simple, but they have a purpose. They ask patients, or family members if patients can’t communicate, for their preferred name. She says it’s simple but she’s found that patients are more responsive when called by their preferred name, such as a nickname or shortened version of their name.
Mohanraj says patients or loved ones are asked other questions to get a sense of the patient’s passions.
“We also asked about things that are valuable to them,” she says. “What do they cherish in terms of their hobbies, the humans in their life? Spirituality? Music? What kind of things do they like to watch on television?”
“One of my favorite questions is we ask family members how they would describe the personality of their loved one who might be on a ventilator and can't show us their personality,” Mohanraj says.
Loved ones typically offer “a lot of positive words, but also some cheeky ones as well,” she says.
She also likes to ask how patients would describe a good day in their lives, and how to get them back to having a good day.
Engagement with patients
After launching the program at Mount Sinai Morningside, Mohanraj says she’s been encouraged to see its use in other hospitals in the system. But she says they’ve learned lessons in taking it to other facilities.
She says it’s important for each facility to have a champion, and she says it’s not necessarily the same person in each hospital.
“We have ICUs where the champion is a chaplain,” Mohanraj says. “We have ICUs where it's social workers, and we have ICUs where it's residents and fellows in training.”
Mohanraj says the program is especially valuable in the development of young physicians. She says it’s important for doctors to find ways to connect with patients even with a heavy workload.
“They are going to have patients that don't communicate with them,” she says. “They may experience burnout, they may at times, feel disengaged, and giving them this tool early on in their training to remember that if we connect with the patient and who they are, sort of at their core, at the center of their humanity, through very simple interventions, we can really promote that engagement with patients.”
Mohanraj says she’s encouraged by an increase in “human-centered care.” She says she recalled a resident who valued seeing pictures of a patient in regular clothes and being happy, and seeing the patient through the eyes of friends and family.
As clinicians are getting more attached to patients, Mohanraj says the program is also monitoring for signs of distress among doctors if a patient dies. Clinicians are writing entries in daily diaries, and they are being observed in real time, she says.“We want to make sure that we are tracking for any adverse impacts of this intervention on our trainees' mental health,” Mohanraj says.
Mohanraj says she hopes other hospitals and health systems around the country will try similar programs. She says she’d love to see health systems integrate biographies into their electronic health records, and projected onto a digital screen or even a wall.
But she says hospitals of all sizes and resources could undertake such programs.
“One thing I love about our intervention, it's simple and it's free,” she says. “It takes a little bit of time and human investment.”
Mohanraj says it was designed to be “highly scalable.”
“I really think it's one of the things that was critical when we built this, is that we built it in a way that anybody can do it,” she says. “You don't even need a board. You can just ask these questions and share the information with the team on rounds.”
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