The daily practice in critical care units is to treat life-threatening illness and prolong life, often at significant burden. What happens when the patient/family/healthcare team decides that the treatment is futile and not in the patient’s best interests, and says “No more”? A multidisciplinary program was developed in this 400-bed community hospital to provide palliative care in this critical care setting.
A team of intensivisits and other physicians, nurses, social workers and chaplains created a program of providing palliative care, including a hospital-wide program in advance care planning, multidisciplinary patient care rounds, a daily Patient Goals Sheet that includes palliative care as an option, family conferences, a Comfort Care Pathway, a full-time hospital Palliative Care Coordinator, and pre-printed order set for ventilator withdrawal of the dying patient. Data were collected using a critical care software that compared results to a national database of like hospital beds, as well as to published literature.
Analysis revealed that 87% of CCU admissions had a written Advance Directive compared to 29% of the national database. In the ICU, it was 79% vs. 30% in the comparative database. Patients died on comfort care orders 69% of the time in ICU compared to 35% of the database. In the ICU, it was 75% vs. 40% (see graph). In addition, requests for ethics consults decreased from weekly to once monthly or less. Compared to published literature, palliative end-of-life care was initiated sooner in patients with global cerebral ischemia or sepsis.
An multidisciplinary team effort in palliative care can improve the care of critically ill patients for whom aggressive life-sustaining treatment is no longer productive for the patient.
The burden of aggressive life-sustaining treatment in critical care units can be relieved by an organized multidisciplinary approach to providing palliative care for selected patients for whom aggressive care is thought not to be in the patient’s best interests, and thus reduce prolonged suffering of terminally-ill patients and the inappropriate use of critical care resources.
Paul Selecky, None.