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Transferring patients home to die: what is the potential population in UK critical care units?
  1. Maureen A Coombs1,
  2. Anne-Sophie E Darlington2,
  3. Tracy Long-Sutehall2,
  4. Natalie Pattison3 and
  5. Alison Richardson2
  1. 1Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
  2. 2Faculty of Health Sciences, University of Southampton, Southampton, UK
  3. 3Royal Marsden NHS Foundation Trust, London, UK
  1. Correspondence to Professor Maureen A Coombs, Graduate School of Nursing, Midwifery and Health, Victoria University of Wellington, Capital and Coast District Health Board, Wellington, 6021, New Zealand; maureen.coombs{at}vuw.ac.nz

Abstract

Objectives Most people when asked, express a preference to die at home, but little is known about whether this is an option for critically ill patients. A retrospective cohort study was undertaken to describe the size and characteristics of the critical care population who could potentially be transferred home to die if they expressed such a wish.

Methods Medical notes of all patients who died in, or within 5 days of discharge from seven critical care units across two hospital sites over a 12-month period were reviewed. Inclusion/exclusion criteria were developed and applied to identify the number of patients who had potential to be transferred home to die and demographic and clinical data (eg, conscious state, respiratory and cardiac support therapies) collected.

Results 7844 patients were admitted over a 12-month period. 422 (5.4%) patients died. Using the criteria developed 100 (23.7%) patients could have potentially been transferred home to die. Of these 41 (41%) patients were diagnosed with respiratory disease. 53 (53%) patients were conscious, 47 (47%) patients were self-ventilating breathing room air/oxygen via a mask. 20 (20%) patients were ventilated via an endotracheal tube. 76 (76%) patients were not requiring inotropes/vasopressors. Mean time between discussion about treatment withdrawal and time of death was 36.4 h (SD=46.48). No patients in this cohort were transferred home.

Conclusions A little over 20% of patients dying in critical care demonstrate potential to be transferred home to die. Staff should actively consider the practice of transferring home as an option for care at end of life for these patients.

  • Terminal care
  • Transitional care
  • Clinical decisions
  • Received 16 December 2014.
  • Revision received 2 September 2015.
  • Accepted 12 November 2015.

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  • Received 16 December 2014.
  • Revision received 2 September 2015.
  • Accepted 12 November 2015.
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