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Transferring patients home to die: what is the potential population in UK critical care units?

Transferring patients home to die: what is the potential population in UK critical care units?
Transferring patients home to die: what is the potential population in UK critical care units?
OBJECTIVES: Most people when asked, express a preference to die at home, but little is known about whether this is an option for critically ill patients. A retrospective cohort study was undertaken to describe the size and characteristics of the critical care population who could potentially be transferred home to die if they expressed such a wish.

METHODS: Medical notes of all patients who died in, or within 5?days of discharge from seven critical care units across two hospital sites over a 12-month period were reviewed. Inclusion/exclusion criteria were developed and applied to identify the number of patients who had potential to be transferred home to die and demographic and clinical data (eg, conscious state, respiratory and cardiac support therapies) collected.

RESULTS:7844 patients were admitted over a 12-month period. 422 (5.4%) patients died. Using the criteria developed 100 (23.7%) patients could have potentially been transferred home to die. Of these 41 (41%) patients were diagnosed with respiratory disease. 53 (53%) patients were conscious, 47 (47%) patients were self-ventilating breathing room air/oxygen via a mask. 20 (20%) patients were ventilated via an endotracheal tube. 76 (76%) patients were not requiring inotropes/vasopressors. Mean time between discussion about treatment withdrawal and time of death was 36.4?h (SD=46.48). No patients in this cohort were transferred home.

CONCLUSIONS: A little over 20% of patients dying in critical care demonstrate potential to be transferred home to die. Staff should actively consider the practice of transferring home as an option for care at end of life for these patients.
2045-435X
1-4
Coombs, Maureen A.
949f23e9-7ae3-400d-b35e-d80f3d261862
Darlington, Anne-Sophie E.
472fcfc9-160b-4344-8113-8dd8760ff962
Long-Sutehall, Tracy
92a6d1ba-9ec9-43f2-891e-5bfdb5026532
Pattison, Natalie
ef39caa6-a9e2-4d75-87a3-a0e177598eef
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7
Coombs, Maureen A.
949f23e9-7ae3-400d-b35e-d80f3d261862
Darlington, Anne-Sophie E.
472fcfc9-160b-4344-8113-8dd8760ff962
Long-Sutehall, Tracy
92a6d1ba-9ec9-43f2-891e-5bfdb5026532
Pattison, Natalie
ef39caa6-a9e2-4d75-87a3-a0e177598eef
Richardson, Alison
3db30680-aa47-43a5-b54d-62d10ece17b7

Coombs, Maureen A., Darlington, Anne-Sophie E., Long-Sutehall, Tracy, Pattison, Natalie and Richardson, Alison (2015) Transferring patients home to die: what is the potential population in UK critical care units? BMJ Supportive & Palliative Care, 1-4. (doi:10.1136/bmjspcare-2014-000834). (PMID:26628534)

Record type: Article

Abstract

OBJECTIVES: Most people when asked, express a preference to die at home, but little is known about whether this is an option for critically ill patients. A retrospective cohort study was undertaken to describe the size and characteristics of the critical care population who could potentially be transferred home to die if they expressed such a wish.

METHODS: Medical notes of all patients who died in, or within 5?days of discharge from seven critical care units across two hospital sites over a 12-month period were reviewed. Inclusion/exclusion criteria were developed and applied to identify the number of patients who had potential to be transferred home to die and demographic and clinical data (eg, conscious state, respiratory and cardiac support therapies) collected.

RESULTS:7844 patients were admitted over a 12-month period. 422 (5.4%) patients died. Using the criteria developed 100 (23.7%) patients could have potentially been transferred home to die. Of these 41 (41%) patients were diagnosed with respiratory disease. 53 (53%) patients were conscious, 47 (47%) patients were self-ventilating breathing room air/oxygen via a mask. 20 (20%) patients were ventilated via an endotracheal tube. 76 (76%) patients were not requiring inotropes/vasopressors. Mean time between discussion about treatment withdrawal and time of death was 36.4?h (SD=46.48). No patients in this cohort were transferred home.

CONCLUSIONS: A little over 20% of patients dying in critical care demonstrate potential to be transferred home to die. Staff should actively consider the practice of transferring home as an option for care at end of life for these patients.

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More information

Accepted/In Press date: 12 November 2015
e-pub ahead of print date: 1 December 2015
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 387078
URI: http://eprints.soton.ac.uk/id/eprint/387078
ISSN: 2045-435X
PURE UUID: 94121cc4-d79c-49e9-ab9b-9791e724a504
ORCID for Tracy Long-Sutehall: ORCID iD orcid.org/0000-0002-6661-9215
ORCID for Alison Richardson: ORCID iD orcid.org/0000-0003-3127-5755

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Date deposited: 09 Feb 2016 10:18
Last modified: 15 Mar 2024 03:34

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Author: Maureen A. Coombs
Author: Natalie Pattison

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