Background Patients with life limiting illnesses commonly present to hospital acutely and are referred to the Critical Care Outreach Team (CCOT). It is frequently concluded that escalation of care is inappropriate due to the partially or completely irreversible nature of deterioration. In such cases escalation of palliative care is fundamental. We performed a retrospective service evaluation of patient outcome following critical care outreach review in patients deemed unsuitable for critical care admission and evaluated appropriateness of referral to the Specialist Palliative Care Team (SPCT).
Methods This was a two-centre study. Paper medical notes from a were reviewed. SPCT involvement was assessed for appropriateness using a conceptual framework.
Results 50 patients‘ (evaluated by CCOT but unsuitable for a higher level of care between October and December 2018) notes were reviewed. 34 (68%) died and 16 (32%) were discharged. Of those who died, the median time from initial CCOT review to death was 4.5 days. 6 (12%) of patients were referred to the SPCT. A further 7 (14%) were reviewed by the SPCT who proactively identified patients as end of life care through the discontinuation of physiological observations. However, 45 (90%) should have been referred.
Conclusions CCOTs identify patients who are inappropriate for higher-level care. Most of these patients are unlikely to survive their hospital admission and the vast majority would benefit from SPCT review for appropriate symptom management and Advanced Care Planning (ACP). The term Acute Palliative Intervention (API) could be utilised to change the language and culture of care decisions.
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