Paediatric Intensive Care Unit, NIHR Wellcome Trust Southampton Clinical Research Centre, Southampton Children's Hospital, Southampton, UK.
University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Southampton, UK.
Nurs Crit Care. 2019 Jul;24(4):222-228. doi: 10.1111/nicc.12410. Epub 2019 Mar 25.
A significant proportion of hospital deaths occur in intensive care units (ICU) and often follow a decision to limit or withdraw life-sustaining treatment. Facilitating the preferred choice in place of death for babies/children is increasingly being advocated, although the literature on a home death is often limited to case reports.
To examine (a) health care professionals' (HCPs) views and experience of transferring babies/children home to die from intensive care, (b) patient clinical characteristics that HCPs would consider transferring home and (c) barriers to transferring home.
A cross-sectional descriptive web-based survey.
A total of 900 HCPs from paediatric and neonatal ICU across the United Kingdom were invited to participate.
A total of 191 (22%) respondents completed the survey; 135 (70.7%) reported being involved in transferring home to die. However, most (58.4%) had just transferred one or two patients in the last 3 years. Overall, respondents held positive views towards transfer, although there was some evidence of divided opinion. Patients identified as unsuitable for transfer included unstable patients (57.6%) and those in need of cardiovascular support (56%). There was statistically significant difference in views between those with and without experience, in that those with experience had more positive views. The most significant barrier was the lack of access to care in the community.
HCPs view the concept of transferring critically ill babies/children home to die positively but have infrequent experience. Views held about transfers are influenced by previous experience. The clinical instability of patients and access to community care are central to decision-making.
A home death for critically ill babies/children is occurring in the United Kingdom but infrequently. Experience of a transfer home positively influences views and increases confidence. Improved multi-organizational collaboration between ICU and community care teams would assist decision-making and facilitation for a transfer home.
大量医院死亡发生在重症监护病房（ICU），并且经常是在决定限制或停止生命支持治疗之后。越来越多的人提倡为婴儿/儿童提供在家庭中去世的选择，尽管关于家庭死亡的文献通常仅限于病例报告。
检查（a）将婴儿/儿童从重症监护室转移回家死亡的医护人员（HCP）的观点和经验，（b）HCP 认为可以转移回家的患者临床特征，以及（c）转移回家的障碍。
一项横断面描述性网络调查。
邀请英国儿科和新生儿 ICU 的 900 名 HCP 参与。
共有 191 名（22%）受访者完成了调查；135 名（70.7%）报告参与了转移回家死亡。然而，大多数人（58.4%）在过去 3 年中仅转移了一两个患者。总体而言，受访者对转移持积极态度，但也有一些意见分歧。被认为不适合转移的患者包括不稳定患者（57.6%）和需要心血管支持的患者（56%）。有经验和无经验的受访者在观点上存在统计学上的显著差异，有经验的受访者观点更为积极。最大的障碍是社区护理无法获得。
HCP 对将重病婴儿/儿童转移回家死亡的概念持积极态度，但经验很少。对转移的看法受到以往经验的影响。患者的临床不稳定和获得社区护理的机会是决策的核心。
重病婴儿/儿童的家庭死亡在英国正在发生，但很少见。在家中转移的经验会积极影响观点并增加信心。重症监护室和社区护理团队之间的多组织合作的改善将有助于家庭转移的决策和促进。
