scholarly journals Palliative care for terminally ill patients in the intensive care unit: Systematic review and metaanalysis

2016 ◽  
Vol 15 (3) ◽  
pp. 376-383 ◽  
Author(s):  
Belmira D.C.P.C.C. Martins ◽  
Reinaldo A. Oliveira ◽  
Antonio J.M. Cataneo
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Length Of Stay ◽  
Risk Ratio ◽  
Intervention Group ◽  
Terminally Ill ◽  
Terminally Ill Patients ◽  
Palliative Care Teams

AbstractObjective:The purpose of our systematic review was to determine whether the introduction of palliative care (PC) teams reduces length of stay and/or mortality for terminally ill patients (TIPs) in an intensive care unit (ICU).Method:We hoped to examine studies that compared TIPs in an ICU who received end-of-life care following implementation of a PC team (intervention group) to those who received care where PC teams had not yet been introduced (control group). We searched MEDLINE via PubMed, LILACS, Scopus, Embase, and Cochrane CENTRAL (search conducted in December of 2015) without language restrictions. Our outcome measures were length of stay in an ICU, presented as an average difference with a corresponding 95% confidence interval (CI95%), and mortality in the ICU, presented as a risk ratio with a corresponding CI95%. Two of our authors independently extracted all of the data.Results:Of the 399 publications identified, 27 were selected for full-text analysis and 19 were excluded, leaving 8 articles for inclusion, which involved a total of 7,846 patients. A metaanalysis of mortality in the ICU was conducted with four studies. Lower mortality was found in the intervention group: risk ratio = 0.78 (CI95% = 0.70–0.87), p < 0.00001, I2 = 18%. Length of stay in the ICU was presented as a mean and standard deviation in four studies, and the result was a reduction of ~2.5 days in the length of stay with application of the intervention: mean = –2.44 days (CI95% = –4.41 to –0.48), p = 0.01, I2 = 86%.Significance of results:Introduction of palliative care teams can reduce mortality rates in the ICU, and perhaps shorten length of stay in the ICU for terminally ill patients.

The impact of a palliative care unit on mortality rate and length of stay for medical intensive care unit patients

2011 ◽  
Vol 9 (4) ◽  
pp. 387-392 ◽  
Author(s):  
Glen Digwood ◽  
Dana Lustbader ◽  
Renee Pekmezaris ◽  
Martin L. Lesser ◽  
Rajni Walia ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Medical Intensive Care Unit ◽  
Terminally Ill ◽  
Terminally Ill Patients ◽  
Medical Intensive Care ◽  
The Impact

AbstractObjective: This study evaluates the impact of a 10-bed inpatient palliative care unit (PCU) on medical intensive care unit (MICU) mortality and length of stay (LOS) for terminally ill patients following the opening of an inpatient PCU. We hypothesized that MICU mortality and LOS would be reduced through the creation of a more appropriate location of care for critically ill MICU patients who were dying.Method: We performed a retrospective electronic database review of all MICU discharges from January 1, 2006 through December 31, 2009 (5,035 cases). Data collected included MICU mortality, MICU LOS, and mean age. The PCU opened on January 1, 2008. We compared location of death for MICU patients during the 2-year period before and the 2-year period after the opening of the PCU.Results: Our data showed that the mean MICU mortality and MICU LOS both significantly decreased following the opening of the PCU, from 21 to 15.8% (p = 0.003), and from 4.6 to 4.0 days (p = 0.014), respectively.Significance of results: The creation of an inpatient PCU resulted in a statistically significant reduction in both MICU mortality rate and MICU LOS, as terminally ill patients were transitioned out of the MICU to the PCU for end-of-life care. Our data support the hypothesis that a dedicated inpatient PCU, capable of providing care to patients requiring mechanical ventilation or vasoactive agents, can protect terminally ill patients from an ICU death, while providing more appropriate care to dying patients and their loved ones.

The feelings and spirituality identified in relatives of terminally ill patients in intensive care

2011 ◽  
Vol 5 (10) ◽  
pp. 2391
Author(s):  
Jefferson Nery Correia ◽  
Karina Da Rosa
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Family Members ◽  
Terminally Ill ◽  
Spiritual Needs ◽  
Adult Intensive Care Unit ◽  
Terminally Ill Patients ◽  
Registration Number ◽  
Terapia Intensiva

ABSTRACT Objective: to analyze the feelings and the presence of spirituality on the behavior and decisions taken by relatives of patients without possibility of cure admitted to an adult intensive care unit. Methodology: this is qualitative study, conducted with the families of terminally ill patients hospitalized in a critical care unit. The criteria for inclusion in the study were: be over 18 years of a patient hospitalized in an adult intensive care unit with a diagnosis of pathology with no chance of cure. Data collection was performed through interviews. Data were examined using content analysis. The study was approved by the Ethics Committee of the Faculdade Integrado de Campo Mourão (PR) with the registration number 65457. Results: after analysis of the speeches, two categories were identified, the first related to the feelings experienced by family members, and the second on the presence of spirituality on the decision of palliative care in intensive care. Conclusion: the family members are influenced by feelings and spirituality regarding the decision to adopt orthothanasia to the terminal patient. The nurse should be aware of the holistic and humanizing aspects, especially the emotional and spiritual needs in the possibility of palliative care in the intensive care unit. Descriptors: palliative care, intensive care units, family, spirituality, nursing.RESUMO Objetivo: analisar os sentimentos e a presença da espiritualidade no comportamento e nas decisões tomadas por familiares de pacientes fora de possibilidade de cura internados em uma unidade de terapia intensiva adulto. Metodologia: estudo qualitativo, realizado com familiares de pacientes terminais internados em uma unidade de cuidados críticos. Os critérios de inclusão na pesquisa foram: ser familiar maior de 18 anos de paciente internado em uma unidade de terapia intensiva adulto com o diagnóstico de patologia fora de possibilidade de cura. A coleta de dados foi realizada por meio de entrevista. Os dados foram analisados pela técnica de análise de conteúdo. A pesquisa foi aprovada pelo Comitê de Ética da Faculdade Integrado de Campo Mourão (PR) com o registro número 52/10. Resultados: após análise das falas foram identificadas duas categorias, a primeira relacionada aos sentimentos vivenciados pelos familiares e a segunda sobre a presença da espiritualidade na decisão dos cuidados paliativos em terapia intensiva. Conclusão: os familiares são influenciados pelos sentimentos e pela espiritualidade quando se trata da decisão de adotar ortotanásia ao paciente terminal. O enfermeiro deve considerar maior atenção aos aspectos holísticos e de humanização, em especial as necessidades emocionais e espirituais na possibilidade de cuidados paliativos na unidade de terapia intensiva. Descritores: cuidados paliativos; unidades de terapia intensiva; família; espiritualidade; enfermagem.RESUMEN Objetivo: analizar los sentimientos de la espiritualidad y la presencia en el comportamiento y las decisiones adoptadas por familiares de pacientes ajenos a posibilidad de una curación ingresados en unidades de cuidados intensivos para adultos. Metodología: estudio cualitativo, realizado con familias de pacientes terminales hospitalizados en una unidad de cuidados intensivos. Los criterios de inclusión en el estudio fueron: la família, mayores de 18 años de pacientes ingresados en una unidad de cuidados intensivos de adultos, con un diagnóstico de la patología oportunidad ajena a curación. La recolección de datos se realizó mediante entrevistas. Los datos fueron analizados utilizando el análisis de contenido. El estudio fue aprobado por el Comité de Ética de la Faculdade Integrado de Campo Mourão (PR) con el número de registración 52/10. Resultados: tras el análisis de los discursos se identificaron dos categorías, la primera relacionada con los sentimientos que prueban los familiares y el segunda sobre la presencia de la espiritualidad en la decisión de los cuidados paliativos en terapia intensiva. Conclusión: los miembros familiares se influencian por los sentimientos y espiritualidad con respeto a la decisión para adoptar el ortotanasia al paciente terminal. La enfermera debe considerar uma mayor atención a los aspectos de humanización y holístico, sobre todo las necesidades emocionales y espirituales de la posibilidad de cuidado paliativo en la unidad del cuidado intensivo. Descriptores: cuidados paliativos, unidades de cuidados intensivos, familia, espiritualidad, enfermería.

scholarly journals Safety and efficacy of routine diagnostic test reduction interventions in patients admitted to the intensive care unit: A systematic review and meta-analysis

2021 ◽  
Vol 49 (1) ◽  
pp. 23-34
Author(s):  
Katherine P Hooper ◽  
Matthew H Anstey ◽  
Edward Litton
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Meta Analysis ◽  
Diagnostic Testing ◽  
Intervention Group ◽  
Cochrane Central Register ◽  
Safety And Efficacy ◽  
Significant Difference

Reducing unnecessary routine diagnostic testing has been identified as a strategy to curb wasteful healthcare. However, the safety and efficacy of targeted diagnostic testing strategies are uncertain. The aim of this study was to systematically review interventions designed to reduce pathology and chest radiograph testing in patients admitted to the intensive care unit (ICU). A predetermined protocol and search strategy included OVID MEDLINE, OVID EMBASE and the Cochrane Central Register of Controlled Trials from inception until 20 November 2019. Eligible publications included interventional studies of patients admitted to an ICU. There were no language restrictions. The primary outcomes were in-hospital mortality and test reduction. Key secondary outcomes included ICU mortality, length of stay, costs and adverse events. This systematic review analysed 26 studies (with more than 44,00 patients) reporting an intervention to reduce one or more diagnostic tests. No studies were at low risk of bias. In-hospital mortality, reported in seven studies, was not significantly different in the post-implementation group (829 of 9815 patients, 8.4%) compared with the pre-intervention group (1007 of 9848 patients, 10.2%), (relative risk 0.89, 95% confidence intervals 0.79 to 1.01, P = 0.06, I2 39%). Of the 18 studies reporting a difference in testing rates, all reported a decrease associated with targeted testing (range 6%–72%), with 14 (82%) studies reporting >20% reduction in one or more tests. Studies of ICU targeted test interventions are generally of low quality. The majority report substantial decreases in testing without evidence of a significant difference in hospital mortality.

scholarly journals Relationships Among Palliative Care, Ethical Climate, Empowerment, and Moral Distress in Intensive Care Unit Nurses

2018 ◽  
Vol 27 (4) ◽  
pp. 295-302 ◽  
Author(s):  
Krista Wolcott Altaker ◽  
Jill Howie-Esquivel ◽  
Janine K. Cataldo
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
Ethical Climate ◽  
Moral Distress ◽  
Care Delivery ◽  
National Database ◽  
Palliative Care Teams ◽  
Intensive Care Unit Nurses ◽  
Distress Scale

Background Intensive care unit nurses experience moral distress when they feel unable to deliver ethically appropriate care to patients. Moral distress is associated with nurse burnout and patient care avoidance. Objectives To evaluate relationships among moral distress, empowerment, ethical climate, and access to palliative care in the intensive care unit. Methods Intensive care unit nurses in a national database were recruited to complete an online survey based on the Moral Distress Scale–Revised, Psychological Empowerment Index, Hospital Ethical Climate Survey, and a palliative care delivery questionnaire. Descriptive, correlational, and regression analyses were performed. Results Of 288 initiated surveys, 238 were completed. Participants were nationally representative of nurses by age, years of experience, and geographical region. Most were white and female and had a bachelor’s degree. The mean moral distress score was moderately high, and correlations were found with empowerment (r = −0.145; P = .02) and ethical climate scores (r = −0.354; P &lt; .001). Relationships between moral distress and empowerment scores and between moral distress and ethical climate scores were not affected by access to palliative care. Nurses reporting palliative care access had higher moral distress scores than those without such access. Education, ethnicity, unit size, access to full palliative care team, and ethical climate explained variance in moral distress scores. Conclusions Poor ethical climate, unintegrated palliative care teams, and nurse empowerment are associated with increased moral distress. The findings highlight the need to promote palliative care education and palliative care teams that are well integrated into intensive care units.

Improving Family Communications at the End of Life: Implications for Length of Stay in the Intensive Care Unit and Resource Use

2003 ◽  
Vol 12 (4) ◽  
pp. 317-324 ◽  
Author(s):  
Tom Ahrens ◽  
Valerie Yancey ◽  
Marin Kollef
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
End Of Life ◽  
Resource Utilization ◽  
Intervention Group ◽  
Clinical Nurse Specialist ◽  
Control Group ◽  
Nurse Specialist ◽  
Clinical Nurse

• Background Inadequate communication persists between healthcare professionals and patients and patients’ families in intensive care units. Unwanted or ineffective treatments can occur when patients’ goals of care are unknown or not honored, increasing costs and care. Having the primary physician provide medical information and then having a physician and clinical nurse specialist team improve opportunities for patients and their families to process that information could improve the situation. This model has not been tested for its effect on patients’ outcomes and resource utilization.• Objectives To evaluate the effect of a communication team that included a physician and a clinical nurse specialist on length of stay and costs for patients near the end of life in the intensive care unit.• Methods During a 1-year period, patients judged to be at high risk for death (N = 151) were divided into 2 groups: 43 patients who were cared for by the medical director teamed with a clinical nurse specialist and 108 patients who received standard care, provided by an attending physician.• Results Compared with the control group, patients in the intervention group had significantly shorter stays in both the intensive care unit (6.1 vs 9.5 days) and the hospital (11.3 vs 16.4 days) and had lower fixed ($15 559 vs $24 080) and variable ($5087 vs $8035) costs.• Conclusions Use of a physician and a clinical nurse specialist focused on improving communication with patients and patients’ families reduced lengths of stay and resource utilization.

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