OBJECTIVES: Timely multidisciplinary family meetings (TMFMs) promote shared decision-making. Despite guidelines that recommend meetings for all patients with serious illness, our NICU TMFM rate was 10%. In this study, we aimed to document a meeting within 5 days of hospitalization for 50% of all new NICU patients hospitalized for ≥5 days within 1 year of introducing interventions. METHODS: A multidisciplinary improvement team used the Model for Improvement to achieve the study aim by targeting key drivers of change. To make meetings easier, we introduced scheduling and documentation tools. To make meetings more customary, we provided education and reminders to professionals. We defined a TMFM as a documented discussion between a parent, a neonatologist, and a nonphysician professional, such as a nurse, within 5 days of hospitalization. We used statistical process control charts to assess the monthly proportion of new patients with a TMFM. In surveys and feedback sessions, family and clinician satisfaction with communication was assessed. RESULTS: TMFM documentation tripled during the intervention year when compared with the previous year (28 of 267 [10.5%] vs 70 of 224 [31.3%]; P < .001), revealing evidence of special cause variation on the statistical process control chart. Clinicians predominantly used ad hoc documentation instead of our scheduling and documentation tools. Parental satisfaction with care and communication did not vary significantly after interventions. Most physicians reported satisfaction with meetings. Nurses reported feeling empowered to request meetings. CONCLUSIONS: An academic, quaternary-care NICU tripled TMFM documentation after introducing a multifaceted intervention. This improvement may represent changes in professionals’ attitudes about providing and documenting family meetings.

Introduction/Objective The autopsy is an undervalued and underutilized resource in medicine. Many people believe autopsies are used solely in forensics while in fact much of what we know about human disease comes from examining the human body at autopsy. The decrease in requests for autopsy over the past several decades possibly results from medical professionals’ lack of exposure to and understanding of autopsy. We conducted a survey to explore non-pathologist physicians’ exposure to and understanding of the autopsy and discover challenges and barriers faced by non-pathologists when requesting an autopsy. Better understanding of non-pathologist physicians’ views and experiences can guide further inquiry or intervention to remove barriers to autopsy requests. Methods/Case Report We disseminated a Google Forms survey via Twitter, tweeting weekly between 10/26/20- 2/26/2021 to obtain a convenience sample. Mean differences in continuous variables were assessed using an independent samples T-test. Chi-squared analyses were employed to report proportional differences in categorical variables. Where appropriate, comparisons of Likert scores (percentages) were performed using ordinal regression methods and reported as odds ratios. Analyses were performed on SPSS statistical software (v.27). P-value was considered significant if <0.05. Results (if a Case Study enter NA) 162 physicians responded to the survey. 29 responses were excluded (work outside US, practice pathology, or in residency), resulting in 133 surveys for analysis. Preliminary analysis suggests that Likert scores were generally favorable (>3) for questions that asked whether the autopsy was of benefit to the clinical team, public health, and family closure. Also, Likert scores revealed that physicians experience barriers surrounding the autopsy in terms of understanding and comfort with tasks related to the autopsy. Conclusion Our study reveals that physicians are often unsure about the cause of their patients’ death, highlighting the continued importance of the autopsy in patient care. Barriers to autopsy use may include limited understanding of the procedure, how it is financed, and how to request an autopsy. Physicians also express discomfort with discussing autopsy with families. Education and specific training on conversations about the autopsy may increase use.