PURPOSE: It is estimated that 20% of Americans die after receiving critical care each year. Improving care at the end-of-life must be a critical care priority. We implemented a program to address the care of patients dying while receiving mechanical ventilation.
METHODS: We instituted a multifaceted program in a university-affiliated, urban hospital center. The components of the program included: creation of a policy on end-of-life care including an order form for the withdrawal of mechanical ventilation; education of physicians and nurses through grand rounds in all major departments, team rounds, nursing inservices; palliative care consultations; and the development of a designated palliative care unit (outside of the ICU) for patients receiving mechanical ventilation at the end of life.
RESULTS: Over a one-year period, educational programs were provided to physicians and nurses in the Departments of Medicine, Surgery and Emergency Medicine, and all Critical Care Units. A palliative unit was established on the geriatrics unit, after training of the geriatric nursing staff to manage patients on mechanical ventilation and provide palliative medications. Palliative care consultations were requested in 38 patients in critical care units; 34 were subsequently transferred out of critical care. Twenty-eight patients requiring mechanical ventilation were admitted to the palliative unit. Patients were admitted from all intensive care units and the Emergency Department. All 28 patients died, 13 after withdrawal of mechanical ventilation.
CONCLUSION: We implemented a program to improve end-of-life care in mechanically ventilated patients. With intensive education and training of existing staff, special programs and units were developed to manage these patients in an atempt to provide optimal, humane care at the end of life both in the ICU and outside the ICU.
CLINICAL IMPLICATIONS: Providing a humane, peaceful and dignified death must be a priority in critical care medicine. The physician and nursing leadership can develop and implement a successful program designed to improve the care of dying patients who are receiving mechanical ventilation.
DISCLOSURE: Janet Shapiro, None.