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TRANSFERRING CRITICALLY ILL PATIENTS HOME TO DIE: DEVELOPMENT OF A GUIDELINE FOR CLINICAL PRACTICE
  1. ASE Darlington1,
  2. T Long-Sutehall1,
  3. A Richardson1 and
  4. M Coombs2
  1. 1University of Southampton, UK
  2. 2Victoria University, New Zealand

    Abstract

    Introduction Transfer home to die from critical care is rare despite health policy supporting patient choice concerning preferred place of care at end of life. A clinical guideline to inform decision making about the rapid transfer of critically ill patients home was developed based on data from a two year mixed methods study.

    Aim(s) and method(s) In a multi-phased study, data was sequentially gathered from a) focus groups with health professionals and service users b) national survey of critical care doctors and nurses, c) interviews with critical care staff, d) audit of patients who had died on critical care units and e) a national stakeholder event. Data was then used to inform development of a clinical guideline, which then underwent initial review and refinement.

    Results The aim of the guideline was to aid health professionals in making decisions about the rapid transfer of patients from critical care home to die. The guideline was structured to incorporate four discrete phases: 1) potential for transfer focussing on patient characteristics and patient/ relatives' preference, 2) pre-transfer arrangements focussing on equipment, documentation, and communication with other agencies 3) peri-transfer and 4) post-transfer focussing on follow-up contact with relatives and community health professionals, and staff debriefing.

    Conclusion(s) The clinical guideline was developed based on robust evidence collected through this comprehensive study. The guideline requires further testing in clinical practice but initial feedback from experienced clinicians has indicated that it may be helpful in terms decision-making, organisation and discussions with patients and families.

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