Intensive Caring UnitF. Amos Bailey, MD Mar 10, 2020
What a quandary! Family members in a recent study rated the quality of end-of-life care in ICU as higher than other parts of the hospital for their family members who has recently died. In our palliative care work we are struggling to help people who are at EOL to avoid or to get out of the ICU.
Are there some things about the ICU which may improve family members ratings? I can think of a few.
Nurses who have fewer patients assigned to them have more time… to provide care ….to talk.
The doctors often are assigned to those units and they are around more and have more time to talk.
It is easy to see how you would feel more supported.
The person who dies today in the hospital is the sickest person that day and needs lots of support. When we started the Safe Harbor Palliative Care Unit at the Birmingham VA it was on the same floor and down the hall from the ICU. We got lots of transfers and we were ready. We had increased our staff with RN’s and CNAs and had a doctor and Fellow assigned to this 10-bed unit. One day a medical student commented that we were like an ICU, an Intensive CARING Unit.
We need to provide the right care, which is Intensive, while avoiding interventions or aspects of the ICU which are no longer consistent with goals and values.
Rolnick, J. A., et al. (2020) The Quality of End-of-Life Care Among Intensive Care Unit Versus Ward Decedents. American Journal of Respiratory and Critical Care Medicine. doi.org/10.1164/rccm.201907-1423OC.