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Kaniecki DM, Grabowski RL, Holloway D, Brown A, Lorenz LA. Nurse Practitioners in Critical Care Transport. Air Med J 2024; 43:163-167. [PMID: 38490781 DOI: 10.1016/j.amj.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/04/2023] [Accepted: 01/04/2024] [Indexed: 03/17/2024]
Abstract
The inclusion of nurse practitioners (NPs) in critical care transport teams has the potential to enhance patient care and improve team operations. NPs can manage complex clinical situations during transport and excel in various roles such as leadership, education, mentoring, research, quality improvement, and clinical expertise. As we navigate the evolving landscape of critical care transport, it is crucial to explore the potential benefits offered by NPs. Their distinct skills and experiences effectively position them to improve patient outcomes, enhance team performance, and contribute to health care's financial sustainability. This article discusses the role of NPs in critical care transport, providing insight into their current uses, and recommendations for optimal use.
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Affiliation(s)
- David M Kaniecki
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH; Cleveland Metro Life Flight, MetroHealth System, Cleveland, OH.
| | - Robert L Grabowski
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH; Cleveland Metro Life Flight, MetroHealth System, Cleveland, OH
| | - David Holloway
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH; Cleveland Clinic Critical Care Transport, Cleveland Clinic, Cleveland, OH
| | - Abigail Brown
- Cleveland Clinic Critical Care Transport, Cleveland Clinic, Cleveland, OH
| | - Lisa A Lorenz
- Cleveland Clinic Critical Care Transport, Cleveland Clinic, Cleveland, OH
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Kistler EA, Hayes MM. Medical Billing: It All Adds Up to Quality. ATS Sch 2023; 4:122-125. [PMID: 37538080 PMCID: PMC10394593 DOI: 10.34197/ats-scholar.2023-0014vl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/06/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Emmett A. Kistler
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
- Fellowship in Patient Safety and Quality, Harvard Medical School, Boston, Massachusetts
| | - Margaret M. Hayes
- Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; and
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Padilla Fortunatti C, De Santis JP, Munro CL. Family Satisfaction in the Adult Intensive Care Unit: A Concept Analysis. ANS Adv Nurs Sci 2021; 44:291-305. [PMID: 33624988 DOI: 10.1097/ans.0000000000000360] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Admission of patients to an intensive care unit is often a stressful event for family members. In the context of patient- and family-centered care, family satisfaction is recognized as a quality indicator of intensive care unit care. However, family satisfaction has not been consistently used or conceptualized in the literature. A modified version of Walker and Avant's method for concept analysis was utilized to examine the concept of family satisfaction in the adult intensive care unit. Antecedents, attributes, consequences, and empirical referents of family satisfaction are presented and implications for practice, research, and policy.
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Affiliation(s)
- Cristobal Padilla Fortunatti
- University of Miami, School of Nursing & Health Studies, Coral Gables, Florida (Ms Padilla Fortunatti and Drs De Santis and Munro); and Department of the Adult and the Senescent, Pontificia Universidad Católica de Chile, School of Nursing, Santiago, Chile (Ms Padilla Fortunatti)
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Zolin SJ, Bhangu JK, Young BT, Posillico SE, Ladhani HA, Claridge JA, Ho VP. Critical Care Documentation for the Dying Trauma Patient: Are We Recognizing Our Own Efforts? Am Surg 2020; 87:1488-1495. [PMID: 33356466 DOI: 10.1177/0003134820972989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Missed documentation for critical care time (CCT) for dying patients may represent a missed opportunity for physicians to account for intensive care unit (ICU) services, including end-of-life care. We hypothesized that CCT would be poorly documented for dying trauma patients. METHODS Adult trauma ICU patients who died between December 2014 and December 2017 were analyzed retrospectively. Critical care time was not calculated for patients with comfort care code status. Critical care time on the day prior to death and day of death was collected. Logistic regression was used to determine factors associated with documented CCT. RESULTS Of 147 patients, 43% had no CCT on day prior to death and 55% had no CCT on day of death. 82% had a family meeting within 1 day of death. Family meetings were independently associated with documented CCT (OR 3.69, P = .008); palliative care consultation was associated with decreased documented CCT (OR .24, P < .001). CONCLUSIONS Critical care time is not documented in half of eligible trauma patients who are near death. Conscious (time spent in family meetings and injury acuity) and unconscious factors (anticipated poor outcomes) likely affect documentation.
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Affiliation(s)
- Samuel J Zolin
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA.,Department of General Surgery, Digestive Disease Institute, 2569Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Jasmin K Bhangu
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA
| | - Brian T Young
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA
| | - Sarah E Posillico
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA
| | - Husayn A Ladhani
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA
| | - Jeffrey A Claridge
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA
| | - Vanessa P Ho
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, Department of Surgery, 2559MetroHealth Medical Center, Cleveland, OH, USA.,Department of Population and Quantitative Health Sciences, 12304Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Oak Y, Kim YS. Attitudes towards Death, Perceptions of Hospice Care, and Hospice Care Needs among Family Members of Patients in the Intensive Care Unit. HAN'GUK HOSUP'ISU WANHWA UIRYO HAKHOE CHI = THE KOREAN JOURNAL OF HOSPICE AND PALLIATIVE CARE 2020; 23:172-182. [PMID: 37497467 PMCID: PMC10332730 DOI: 10.14475/kjhpc.2020.23.4.172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/23/2020] [Accepted: 08/14/2020] [Indexed: 07/28/2023]
Abstract
Purpose This study aimed to identify the relationships among attitudes towards death, perceptions of hospice care, and hospice care needs as perceived by family members of patients in the intensive care unit (ICU). Methods This study used a descriptive correlational method. A structured questionnaire was used to collect data from 114 participating families in the ICU at Dong-A University Hospital, from October 10 to November 1, 2019. The data were analyzed in terms of frequency, percentage, and mean and standard deviation. The t-test, one-way analysis of variance, and Pearson correlation coefficients were also conducted. Results Perceptions of hospice care showed significant differences according to age (F=3.06, P=0.031) and marital status (t=3.55, P=0.001). However, no significant differences in attitudes towards death or hospice care needs were found. A significant positive correlation was found between perceptions of hospice care and hospice care needs (r=0.49, P<0.001). Conclusion In order for families to recognize the need for hospice care and to receive high-quality palliative care at the appropriate time, it is necessary to increase public awareness of hospice care through various educational and awareness-raising efforts, thereby providing opportunities for families of terminally ill patients to request hospice care.
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Affiliation(s)
- Yunha Oak
- Department of Nursing, Dong-A University Hospital,
*Department of Nursing, College of Nursing, Catholic University of Pusan, Busan, Korea
| | - Young-Sun Kim
- Department of Nursing, Dong-A University Hospital,
*Department of Nursing, College of Nursing, Catholic University of Pusan, Busan, Korea
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Clinical trials in critical care: can a Bayesian approach enhance clinical and scientific decision making? THE LANCET RESPIRATORY MEDICINE 2020; 9:207-216. [PMID: 33227237 DOI: 10.1016/s2213-2600(20)30471-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 02/07/2023]
Abstract
Recent Bayesian reanalyses of prominent trials in critical illness have generated controversy by contradicting the initial conclusions based on conventional frequentist analyses. Many clinicians might be sceptical that Bayesian analysis, a philosophical and statistical approach that combines prior beliefs with data to generate probabilities, provides more useful information about clinical trials than the frequentist approach. In this Personal View, we introduce clinicians to the rationale, process, and interpretation of Bayesian analysis through a systematic review and reanalysis of interventional trials in critical illness. In the majority of cases, Bayesian and frequentist analyses agreed. In the remainder, Bayesian analysis identified interventions where benefit was probable despite the absence of statistical significance, where interpretation depended substantially on choice of prior distribution, and where benefit was improbable despite statistical significance. Bayesian analysis in critical care medicine can help to distinguish harm from uncertainty and establish the probability of clinically important benefit for clinicians, policy makers, and patients.
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Hwang DY. Engaging ICU Patients and Families Before the Certainty of Treatment Success or Failure*. Crit Care Med 2019; 47:869-871. [DOI: 10.1097/ccm.0000000000003757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kalani C, Garcia I, Ocegueda-Pacheco C, Varon J, Surani S. The Innovations in Pulmonary Hypertension Pathophysiology and Treatment: What are our Options! CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190117133311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Charlene Kalani
- Bay Area Medical Center, Corpus Christi, Texas, United States
| | - Ismael Garcia
- Dorrington Medical Associates, PA, Houston, Texas, United States
| | | | | | - Salim Surani
- Texas A&M University, College Station, Texas, United States
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Dingfield LE, Kayser JB. Integrating Advance Care Planning Into Practice. Chest 2017; 151:1387-1393. [PMID: 28283409 DOI: 10.1016/j.chest.2017.02.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 02/27/2017] [Accepted: 02/27/2017] [Indexed: 11/19/2022] Open
Abstract
Advanced respiratory diseases progress over time and often lead to death. As the condition worsens, patients may lose medical decision-making ability. Advance care planning (ACP) is a process in which patients receive information about their diagnosis and prognosis; discuss values, goals, and fears; articulate preferences about life-sustaining treatments and end-of-life care; and appoint a surrogate medical decision maker. This process may result in written documentation of patient preferences or the appointment of a health-care power of attorney (HCPOA). ACP discussions have multiple benefits for patients and their surrogate decision makers, including ensuring that the care provided is aligned with the patient's goals and preferences and decreasing stress, anxiety, and burden in surrogates. Time and provider comfort are often cited barriers to ACP, so it may be necessary for clinicians to gain experience in conversations and identify the patients most likely to benefit from ACP discussions. Two new Current Procedural Terminology (CPT) codes, 99497 and 99498, have been recognized by the Centers for Medicare and Medicaid Services (CMS) as of January 1, 2016 and are intended to incentivize clinicians to engage in ACP discussions with their patients earlier and with more frequency. This manuscript reviews the benefits and barriers to ACP in patients with advanced respiratory disease and provides guidance on the use of the new CPT codes for reimbursement of these conversations.
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Affiliation(s)
- Laura E Dingfield
- Palliative Care Service, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Joshua B Kayser
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, and Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
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Palliative Care and Intensive Care Units. J Hosp Palliat Nurs 2016. [DOI: 10.1097/njh.0000000000000218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Edwards JD. Palliative Care and End-of-Life Considerations in Children on Chronic Ventilation. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Integration of Palliative Care Services in the Intensive Care Unit: A Roadmap for Overcoming Barriers. Clin Chest Med 2015; 36:441-8. [PMID: 26304281 DOI: 10.1016/j.ccm.2015.05.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinicians working in the intensive care unit (ICU) confront death and dying daily. ICU care can be inconsistent with a patient's values, preferences, and previously expressed goals of care. Current evidence promotes the integration of palliative care services within the ICU setting. Palliative care bridges the gap between comfort and cure, and these services are growing in the United States. This article discusses the benefits and barriers to integration of ICU and palliative care services, and a stepwise approach to implementation of palliative care services. Integration of palliative care services into ICU workflow is increasingly seen as essential to providing high-quality, comprehensive critical care.
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Aslakson R, Cheng J, Vollenweider D, Galusca D, Smith TJ, Pronovost PJ. Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med 2015; 17:219-35. [PMID: 24517300 DOI: 10.1089/jpm.2013.0409] [Citation(s) in RCA: 168] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Over the last 20 years, multiple interventions to better integrate palliative care and intensive care unit (ICU) care have been evaluated. This systematic review summarizes these studies and their outcomes. METHODS We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Library, and the Web of Science; performed a search of articles published by opinion leaders in the field; and reviewed hand-search articles as of August 13, 2012. The terms "palliative care" and "intensive care unit" were mapped to MeSH subject headings and "exploded." We included trials of adult patients that evaluated an ICU intervention and addressed Robert Wood Johnson group-identified domains of high-quality end-of-life care in the ICU. We excluded case series, editorials, and review articles. We compared two types of interventions, integrative and consultative, focusing on the outcomes of patient and family satisfaction, mortality, and ICU and hospital length of stay (LOS), because these were most prevalent among studies. RESULTS Our search strategy yielded 3328 references, of which we included 37 publications detailing 30 unique interventions. Interventions and outcome measures were heterogeneous, and many studies were underpowered and/or subject to multiple biases. Most of the interventions resulted in a decrease in hospital and ICU LOS. Few interventions significantly affected satisfaction. With one exception, the interventions decreased or had no effect on mortality. There was no evidence of harm from any intervention. CONCLUSIONS Heterogeneity of interventions made comparison of ICU-based palliative care interventions difficult. However, existing evidence suggests proactive palliative care in the ICU, using either consultative or integrative palliative care interventions, decrease hospital and ICU LOS, do not affect satisfaction, and either decrease or do not affect mortality.
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Affiliation(s)
- Rebecca Aslakson
- 1 Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine , Baltimore, Maryland
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Abstract
OBJECTIVES Palliative care is an interprofessional specialty as well as an approach to care by all clinicians caring for patients with serious and complex illness. Unlike hospice, palliative care is based not on prognosis but on need and is an essential component of comprehensive care for critically ill patients from the time of ICU admission. In this clinically focused article, we review evidence of opportunities to improve palliative care for critically ill adults, summarize strategies for ICU palliative care improvement, and identify resources to support implementation. DATA SOURCES We searched the MEDLINE database from inception through January 2014. We also searched the Reference Library of The Improving Palliative Care in the ICU Project website sponsored by the National Institutes of Health and the Center to Advance Palliative Care, which is updated monthly. We hand-searched reference lists and author files. STUDY SELECTION Selected studies included all English-language articles concerning adult patients using the search terms 'intensive care' or 'critical care' with 'palliative care,' 'supportive care,' 'end-of-life care,' or 'ethics.' DATA EXTRACTION : After examination of peer-reviewed original scientific articles, consensus statements, guidelines, and reviews resulting from our literature search, we made final selections based on author consensus. DATA SYNTHESIS Existing evidence is organized to address: 1) opportunities to alleviate physical and emotional symptoms, improve communication, and provide support for patients and families; 2) models and specific interventions for improving ICU palliative care; 3) available resources for ICU palliative care improvement; and 4) ongoing challenges and targets for future research. Key domains of ICU palliative care have been defined and operationalized as measures of quality. There is increasing recognition that effective integration of palliative care during acute and chronic critical illness may help patients and families face challenges after discharge from intensive care. CONCLUSIONS Palliative care is increasingly accepted as an essential component of comprehensive care for critically ill patients, regardless of diagnosis or prognosis. A variety of strategies to improve ICU palliative care appear to be effective, and resources including technical assistance and tools are available to support improvement efforts. As the longer-term impact of intensive care on those surviving acute critical illness is increasingly documented, palliative care can help prepare and support patients and families for challenges after ICU discharge. Further research is needed to inform efforts to integrate palliative care with intensive care more effectively and efficiently in and after the ICU and to document improvement using valid and responsive outcome measures.
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Affiliation(s)
- Rebecca A Aslakson
- 1Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD. 2The Palliative Care Program at the Kimmel Cancer Center at Johns Hopkins, The Johns Hopkins School of Medicine, Baltimore, MD. 3Division of Pulmonary and Critical Care Medicine, Harborview Medical Center, University of Washington, Seattle, WA. 4Division of Pulmonary, Critical Care and Sleep Medicine and Hertzberg Palliative Care Institute, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
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Marcus JD, Mott FE. Difficult conversations: from diagnosis to death. Ochsner J 2014; 14:712-717. [PMID: 25598738 PMCID: PMC4295750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Communication is the cornerstone of good multidisciplinary medical care, and the impact of conversations about diagnosis, treatment, and prognosis is indisputable. Healthcare providers must be able to have difficult conversations that accurately describe diagnostic procedures, treatment goals, and the benefits and/or risks involved. METHODS This paper reviews the literature about the importance of communication in delivering bad news, the status of communication training, communication strategies, and psychosocial interventions. RESULTS Although many published guidelines address difficult communication, communication training is lacking. Consequently, many clinicians may have difficulties with, or in the worst-case scenario, avoid delivering bad news and discussing end-of-life treatment. Clinicians also struggle with how to have the last conversation with a patient and how to support patient autonomy when they disagree with a patient's choices. CONCLUSION There is a clinical imperative to educate physicians and other healthcare workers on how to effectively deliver information about a patient's health status, diagnostic avenues to be explored, and decisions to be made at critical health junctions. Knowing how to implement the most rudimentary techniques of motivational interviewing, solution-focused brief therapy, and cognitive behavioral therapy can help physicians facilitate conversations of the most difficult type to generate positive change in patients and families and to help them make decisions that minimize end-of-life distress.
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Affiliation(s)
- Joel D. Marcus
- Ochsner Cancer Institute, Ochsner Clinic Foundation, New Orleans, LA
| | - Frank E. Mott
- Georgia Regents University Cancer Center, Georgia Regents Health System, Augusta, GA
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Abstract
PURPOSE OF REVIEW End-of-life care and communication deficits are important sources of conflicts within ICU teams and with patients or families. This narrative review describes recent studies on how to improve palliative care and surrogate decision-making in ICUs and compares the results with previously published literature on this topic. RECENT FINDINGS Awareness and use of end-of-life recommendations is still low. Education about end-of-life is beneficial for end-of-life decisions. Residency and nurses training programmes start to integrate palliative care education in critical care. Integration of palliative care consults is recommended and probably cost-effective. Projects that promote direct contact of care team members with patients/families may be more likely to improve care than educational interventions for caregivers only. The family's response to critical illness includes adverse psychological outcome ('postintensive care syndrome-family'). Information brochures and structured communication protocols are likely to improve engagement of family members in surrogate decision-making; however, validation of outcome effects of their use is needed. SUMMARY Optimizing palliative care and communication skills is the current challenge in ICU end-of-life care. Intervention strategies should be interdisciplinary, multiprofessional and family-centred in order to quickly reach these goals.
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Graw JA, Spies CD, Wernecke KD, Braun JP. Managing end-of-life decision making in intensive care medicine--a perspective from Charité Hospital, Germany. PLoS One 2012; 7:e46446. [PMID: 23049701 PMCID: PMC3462175 DOI: 10.1371/journal.pone.0046446] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 08/31/2012] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION End-of-life-decisions (EOLD) have become an important part of modern intensive care medicine. With increasing therapeutic possibilities on the one hand and many ICU-patients lacking decision making capacity or an advance directive on the other the decision making process is a major challenge on the intensive care unit (ICU). Currently, data are poor on factors associated with EOLD in Germany. In 2009, a new law on advance directives binding physicians and the patient's surrogate decision makers was enacted in Germany. So far it is unknown if this law influenced proceedings of EOLD making on the ICU. METHODS A retrospective analysis was conducted on all deceased patients (n = 224) in a 22-bed surgical ICU of a German university medical center from 08/2008 to 09/2010. Patient characteristics were compared between patients with an EOLD and those without an EOLD. Patients with an EOLD admitted before and after change of legislation were compared with respect to frequencies of EOLD performance as well as advance directive rates. RESULTS In total, 166 (74.1%) of deaths occurred after an EOLD. Compared to patients without an EOLD, comorbidities, ICU severity scores, and organ replacement technology did not differ significantly. EOLDs were shared within the caregiverteam and with the patient's surrogate decision makers. After law enacting, no differences in EOLD performance or frequency of advance directives (8.9% vs. 9.9%; p = 0.807) were observed except an increase of documentation efforts associated with EOLDs (18.7% vs. 43.6%; p<0.001). CONCLUSIONS In our ICU EOLD proceedings were performed patient-individually. But EOLDs follow a standard of shared decision making within the caregiverteam and the patient's surrogate decision makers. Enacting a law on advance directives has not affected the decision making-process in EOLDs nor has it affected population's advance care planning habits. However, it has led to increased EOLD-associated documentation on the ICU. TRIAL REGISTRATION [corrected] ClinicalTrials.gov NCT01294189.
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Affiliation(s)
- Jan A Graw
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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