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Delivery of end‐of‐life care in an emergency department–based intensive care unit

OBJECTIVE: Intensive care unit (ICU) admissions near the end of life have been associated with worse quality of life and burdensome costs. Patients may not benefit from ICU admission if appropriate end‐of‐life care can be delivered elsewhere. The objective of this study was to descriptively analyze...

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Autores principales: Leith, Thomas B., Haas, Nathan L., Harvey, Carrie E., Chen, Cynthia, Ives Tallman, Crystal, Bassin, Benjamin S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771771/
https://www.ncbi.nlm.nih.gov/pubmed/33392556
http://dx.doi.org/10.1002/emp2.12258
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author Leith, Thomas B.
Haas, Nathan L.
Harvey, Carrie E.
Chen, Cynthia
Ives Tallman, Crystal
Bassin, Benjamin S.
author_facet Leith, Thomas B.
Haas, Nathan L.
Harvey, Carrie E.
Chen, Cynthia
Ives Tallman, Crystal
Bassin, Benjamin S.
author_sort Leith, Thomas B.
collection PubMed
description OBJECTIVE: Intensive care unit (ICU) admissions near the end of life have been associated with worse quality of life and burdensome costs. Patients may not benefit from ICU admission if appropriate end‐of‐life care can be delivered elsewhere. The objective of this study was to descriptively analyze patients receiving end‐of‐life care in an emergency department (ED)–based ICU (ED‐ICU). METHODS: This is a retrospective analysis of patient outcomes and resource use in adult patients receiving end‐of‐life care in an ED‐ICU. In 2015, an “End of Life” order set was created to standardize delivery of palliative therapies and comfort measures. We identified adult patients (>18 years) receiving end‐of‐life care in the ED‐ICU from December 2015 to March 2020 whose clinicians used the end‐of‐life order set. RESULTS: A total of 218 patients were included for analysis; 50.5% were female, and the median age was 73.6 years. The median ED‐ICU length of stay was 13.3 hours (interquartile range, 7.4–20.6). Two patients (0.9%) were admitted to an inpatient ICU, 117 (53.7%) died in the ED‐ICU, 77 (35.3%) were admitted to a non–intensive care inpatient service, and 22 (10.1%) were discharged from the ED‐ICU. CONCLUSIONS: An ED‐ICU can be used for ED patients near the end of life. Only 0.9% were subsequently admitted to an ICU, and 10.1% were discharged from the ED‐ICU. This practice may benefit patients and families by avoiding costly ICU admissions and benefit health systems by reducing ICU capacity strain.
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spelling pubmed-77717712020-12-31 Delivery of end‐of‐life care in an emergency department–based intensive care unit Leith, Thomas B. Haas, Nathan L. Harvey, Carrie E. Chen, Cynthia Ives Tallman, Crystal Bassin, Benjamin S. J Am Coll Emerg Physicians Open Palliative Care OBJECTIVE: Intensive care unit (ICU) admissions near the end of life have been associated with worse quality of life and burdensome costs. Patients may not benefit from ICU admission if appropriate end‐of‐life care can be delivered elsewhere. The objective of this study was to descriptively analyze patients receiving end‐of‐life care in an emergency department (ED)–based ICU (ED‐ICU). METHODS: This is a retrospective analysis of patient outcomes and resource use in adult patients receiving end‐of‐life care in an ED‐ICU. In 2015, an “End of Life” order set was created to standardize delivery of palliative therapies and comfort measures. We identified adult patients (>18 years) receiving end‐of‐life care in the ED‐ICU from December 2015 to March 2020 whose clinicians used the end‐of‐life order set. RESULTS: A total of 218 patients were included for analysis; 50.5% were female, and the median age was 73.6 years. The median ED‐ICU length of stay was 13.3 hours (interquartile range, 7.4–20.6). Two patients (0.9%) were admitted to an inpatient ICU, 117 (53.7%) died in the ED‐ICU, 77 (35.3%) were admitted to a non–intensive care inpatient service, and 22 (10.1%) were discharged from the ED‐ICU. CONCLUSIONS: An ED‐ICU can be used for ED patients near the end of life. Only 0.9% were subsequently admitted to an ICU, and 10.1% were discharged from the ED‐ICU. This practice may benefit patients and families by avoiding costly ICU admissions and benefit health systems by reducing ICU capacity strain. John Wiley and Sons Inc. 2020-09-27 /pmc/articles/PMC7771771/ /pubmed/33392556 http://dx.doi.org/10.1002/emp2.12258 Text en © 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Palliative Care
Leith, Thomas B.
Haas, Nathan L.
Harvey, Carrie E.
Chen, Cynthia
Ives Tallman, Crystal
Bassin, Benjamin S.
Delivery of end‐of‐life care in an emergency department–based intensive care unit
title Delivery of end‐of‐life care in an emergency department–based intensive care unit
title_full Delivery of end‐of‐life care in an emergency department–based intensive care unit
title_fullStr Delivery of end‐of‐life care in an emergency department–based intensive care unit
title_full_unstemmed Delivery of end‐of‐life care in an emergency department–based intensive care unit
title_short Delivery of end‐of‐life care in an emergency department–based intensive care unit
title_sort delivery of end‐of‐life care in an emergency department–based intensive care unit
topic Palliative Care
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7771771/
https://www.ncbi.nlm.nih.gov/pubmed/33392556
http://dx.doi.org/10.1002/emp2.12258
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