The goal of relieving suffering and providing for a dignified death has become an increasingly important goal of critical care.
A multidisciplinary team composed of critical care physicians/nurses, pharmacists and social workers was developed in 2003 to provide palliative care for the critically ill. Families were asked to rate care on a scale ranging from 1 (very poor) to 5 (excellent).
Of the 1622 critical care consultations performed in 2003 by the Medical Intensive Care Unit (MICU), 194 (12%) were referred to the palliative team. One hundred and one were admitted to the general medical floor and 93 to the MICU. Do not resuscitate orders were obtained in 90 (97%) of these patients compared to 41% of overall MICU patients (P=0.001). Care was withdrawn or withheld in 92 of 93 (99%) patients receiving palliative care versus 22% of all MICU patient (P=0.001). Mortality in the palliative care group was 100% compared to overall MICU mortality of 13% (P<0.001). Families rated the medical care 4.7 for all MICU patients versus 4.8 in the palliative care group. Education was rated 4.4 for overall MICU patients versus 4.7 in the palliative care group (p=0.05). Families had more trust in the staff in the palliative care group (4.8) versus overall MICU patients 4.4 (P=0.05). Both groups felt they were treated with respect and dignity - 4.8 in both groups.
A multidisciplinary team approach improves palliative care for dying critically ill patients and improves family satisfaction.
Intensivists need to focus upon palliative care for their patients.
V. Malik, None.