Article Text

Download PDFPDF
Palliative medicine in the intensive care unit: needs, delivery, quality
  1. Stephanie A Hill1,
  2. Abdul Dawood1,
  3. Elaine Boland2,
  4. Hannah E Leahy2 and
  5. Fliss EM Murtagh3
  1. 1 Intensive Care Unit, Hull University Teaching Hospitals NHS Trust, Hull, Kingston upon Hull, UK
  2. 2 Palliative Medicine, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
  3. 3 Wolfson Palliative Care Research Centre, University of Hull, Hull, Kingston upon Hull, UK
  1. Correspondence to Dr Stephanie A Hill, Hull University Teaching Hospitals NHS Trust, Hull HU3 2JZ, Kingston upon Hull, UK; stephanie.hill11{at}nhs.net

Abstract

Background 15%–20% of critical care patients die during their hospital admission. This service evaluation assesses quality of palliative care in intensive care units (ICUs) compared with national standards.

Methods Retrospective review of records for all patients who died in four ICUs (irrespective of treatment limitation) between 1 June and 31 July 2019. Descriptive statistics reported for patient characteristics, length of stay, admission route, identification triggers and palliative care delivery.

Results Forty-five patients died, two records were untraced, thus N=43. The dying process was recognised in 88% (n=38). Among those where dying was recognised (N=35), 97% (34) had documented family discussion before death, 9% (3) were offered religious/spiritual support, 11% (4) had review of hydration/nutrition and 6% (2) had documented preferred place of death. Prescription of symptom control medications was complete in 71% (25) opioids, 34% (12) haloperidol, 54% (19) midazolam and 43% (15) hyoscine. Combining five triggers—length of stay >10 days prior to ICU admission 7% (3), multiorgan failure ≥3 systems 33% (14), stage IV malignancy 5% (2), post-cardiac arrest 23% (10) and intracerebral haemorrhage requiring mechanical ventilation 12% (5)—identified 60% (26) of patients. Referral to the palliative care team was seen in 14% (5), and 8% (3) had specialist palliative care team review.

Conclusions Recognition of dying was high but occurred close to death. Family discussions were frequent, but religious/spiritual needs, hydration/nutrition and anticipatory medications were less often considered. The ICUs delivered their own palliative care in conjunction with specialist palliative care input. Combining five triggers could increase identification of palliative care needs, but a larger study is needed.

  • chronic conditions
  • clinical decisions
  • communication
  • end-of-life care
  • service evaluation
  • hospital care

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Footnotes

  • Contributors All authors conceived the service evaluation. SH collected the data. SH and FM analysed the data. SH, as guarantor, and FM drafted the initial manuscript. AD, HEL and EB reviewed and agreed with the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.