Background Achieving patient wishes, including preferred place of death (PPOD), is integral to excellent end of life care. Rapid discharge at end of life has been identified to be a core part of this care in the acute hospital setting. However, what consideration do we give PPOD, when caring for patients in the critical care (CC) setting? We outline a case report and evolution of a checklist to help streamline this process, ensuring patient safety and improved patient care.
Methods We describe a patient with Guillian BarrÃ© Syndrome who was ventilated via a tracheostomy on critical care. After a lengthy admission with no improvement, his discharge home for withdrawal of invasive ventilation and end of life care was jointly supported by the critical care and palliative care teams. Following reflection and learning from this and other cases, the complexities involved with a discharge of this type were identified. To achieve safe and effective care and provide direction to a process unfamiliar to many, a joint checklist was developed.
Results Our checklist has been well received by the wider critical care and specialist palliative care teams (SPCT). It aims to co-ordinate and clearly identify task responsibility.
Key learning incorporated into the checklist includes:
Early involvement of the SPCT
Joint CC & SPCT discussions with family are crucial
Regular communication between primary and secondary care services
Avoiding same day or weekend discharge
Conclusions The checklist is in its pilot phase. Evaluation is planned for February 2021. Adaptations, if required, shall be made when this data is available. Discharge home from critical care for patients who are dying is possible. To ensure fair and equitable care for all, PPOD should be discussed and explored for patients in ITU, and although a complex process, it is achievable and highly rewarding for all involved.
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