1Emory Palliative Care Center, Emory University, Atlanta, GA. 2U.S. Department of Veterans Affairs Medical Center and Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA. 3Department of Surgery, Emory University School of Medicine, Atlanta, GA. 4Emory Center for Critical Care Medicine, Emory University, Atlanta, GA.
Crit Care Med. 2014 May;42(5):1074-80. doi: 10.1097/CCM.0000000000000120.
End-of-life care is frequently provided in the ICU because patients receiving life-sustaining treatments are often unsuitable for transfer to home or community hospices. In-hospital dedicated hospice inpatient units are a novel option. This study was designed to 1) demonstrate the feasibility of ICU to dedicated hospice inpatient unit transfer in critically ill terminal patients; 2) describe the clinical characteristics of those transferred and compare them to similar patients who were not transferred; and 3) assess the operational and economic impact of dedicated hospice inpatient units.
Retrospective chart review.
ICUs and dedicated hospice inpatient units at two southeast urban university hospitals.
Charts of ICU and dedicated hospice inpatient unit deaths over a 6-month period were reviewed.
Dedicated hospice inpatient unit transfers were identified from hospice administrator records. Missed opportunities were patients admitted to the hospital for more than 48 hours who either adopted a comfort care course or had a planned termination of life-sustaining therapy. Patients were excluded if they were declared brain dead, were organ donors, required high-frequency ventilation, or if there was insufficient information in the medical record to make a determination.
We identified 167 transfers and 99 missed opportunities; 37% of appropriate patients were not transferred. Transfers were older (66.9 vs 60.4 yr; p < 0.05), less likely to use mechanical ventilation (71.9% vs 90.9%) and vasopressors (70.9% vs 95.0%; p < 0.05), and less likely to receive a palliative care consult (70.4% vs 43.4%; p < 0.05) than missed opportunities. Transfers saved 585 ICU bed days.
Dedicated hospice inpatient units are a feasible way to provide care for terminal ICU patients, but barriers including lack of knowledge of the units and provider or family comfort with leaving the ICU remain. Dedicated hospice inpatient units are potentially significant sources of bed days and cost savings for hospitals and the healthcare system overall.
由于接受生命支持治疗的患者通常不适合转回家或社区临终关怀院，因此经常在 ICU 提供临终关怀。住院专科临终关怀病房是一种新的选择。本研究旨在：1）证明将危重症终末期患者从 ICU 转至专科临终关怀病房的可行性；2）描述转至专科临终关怀病房的患者的临床特征，并将其与未转至专科临终关怀病房的类似患者进行比较；3）评估专科临终关怀病房的运营和经济影响。
回顾性图表审查。
两家东南城市大学医院的 ICU 和专科临终关怀病房。
回顾了在六个月期间 ICU 和专科临终关怀病房死亡患者的病历。
从临终关怀管理员的记录中确定了专科临终关怀病房的转院患者。错失的机会是指那些在医院住院超过 48 小时的患者，他们要么采取了舒适护理方案，要么计划终止生命支持治疗。如果患者被宣布脑死亡、器官捐献者、需要高频通气或病历中没有足够的信息来做出判断，则将其排除在外。
我们确定了 167 次转院和 99 次错失机会；37%的合适患者未转院。转院患者年龄更大（66.9 岁比 60.4 岁；p < 0.05），较少使用机械通气（71.9%比 90.9%）和血管加压素（70.9%比 95.0%；p < 0.05），较少接受姑息治疗咨询（70.4%比 43.4%；p < 0.05）。转院节省了 585 个 ICU 床位日。
住院专科临终关怀病房是为终末期 ICU 患者提供护理的一种可行方法，但仍然存在对这些病房缺乏了解以及医护人员或患者家属对离开 ICU 的舒适感等障碍。住院专科临终关怀病房可能是医院和整个医疗保健系统重要的床位日和成本节约来源。
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