緩和ケアと医学

抽象的な

Lessons Learned from a Palliative Care-Related Communication Intervention in an Adult Surgical Intensive Care Unit

Rebecca A. Aslakson, Maureen Coyle, Rhonda Wyskiel, Christina Copley, Kathryn Han, Nita Ahuja and Peter J Pronovost

Purpose: Multi-disciplinary, palliative care-related family meetings for intensive care unit(ICU) patients can decrease ICU length-of-stay and family anxiety and distress, but it is unclear how to arrange such meetings in surgical ICUs (SICUs). Materials and Methods: Through meetings with SICU clinician stakeholders, we determined trigger criteria and intervention content. We piloted the intervention over 6 months in a single, 16-bed adult SICU. Results: Clinician stakeholders reached consensus for a 7 day trigger criteria. A social worker arranged the multi-disciplinary meetings. During the six month pilot, 25 patients were identified but only approximately 60% received meetings. The 7 day trigger identified a patient population with high in-hospital mortality (44%) and prolonged ICU and hospital median lengths of stay (34 and 43 days, respectively). The pilot was stopped at 6 months due to high burden of work for social workers and an inability to standardize meeting content. Conclusion: The 7 day criteria for SICU admission identified a subset of high mortality SICU patients likely to benefit from proactive palliative care-related meetings. Meetings were arranged but the format did not ensure meeting content and the intense time commitment of arranging meetings prevented sustainability.