- Paper Report
- Open Access
Earlier palliative care in ITU nonsurvivors
- Malcolm Watters1
© Biomed Central Ltd 2001
- Received: 16 March 2001
- Published: 3 December 2001
- Illness scoring
Patients who stay for long periods in the ITU and ultimately don't survive comprise 13% of the total but account for 32% of resources. It is inhumane to continue ITU therapies when there is no hope of survival. By having regular discussions with patient, relatives, and the critical care team, can the ITU resources used by patients who ultimately die be reduced?
Median ITU stay reduced from 4 to 3 days. This corresponds to 200 fewer days for every 100 patients. Analysis of subgroups showed that this reduction was in the targeted group, ie the patients with higher APACHE scores who died. The intervention did not increase overall mortality. The result is that dying patients spend less time in the ITU.
Prospective, non-blinded change of practice intervention. Within 72 h of admission anyone with a predicted length of stay of >5 days (from APACHE 3 data) entered the study. 'Clinical milestones' were agreed between the family and ITU team as to what constituted success and failure of treatment. If patients met milestones, new ones were set, and if not, alternatives, including palliative care, were discussed. The team also met to ensure consistency in patients plan.