How do we die? Where do we die? Who decides the answers to these questions? These questions and a few others come to mind when reviewing the article in this month’s CHEST (see page 266), “Impact of a Proactive Approach To Improve End-Of-Life Care in a Medical ICU,” by Guzman and Campbell. Why are studies like this done at medical centers and not at community hospitals? What do patients expect from us at the end of life? Where has the joy in medicine gone?
In their article, Guzman and Campbell looked at end-of-life care for critically ill patients with global cerebral ischemia post-cardiopulmonary resuscitation and multiple organ system failure. In a comparative study at a university hospital medical ICU, they looked at issues related to end-of-life care in critically ill patients with very poor prognoses. They found that by utilizing a prospective, proactive approach to these patients with a palliative care team there was a decreased hospital length of stay with a potential for cost savings. Another major point involved the decreased time between the identification of the poor prognosis and the establishment of comfort care-only measures.