Role of the Rapid Response System in End-of-Life Care Decisions

2020 ◽  
Vol 37 (11) ◽  
pp. 943-949
Author(s):  
Jung Soo Kim ◽  
Man Jong Lee ◽  
Mi Hwa Park ◽  
Jae Yoen Park ◽  
Ah Jin Kim
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Rapid Response ◽  
Secondary Outcome ◽  
Life Care ◽  
Rapid Response System ◽  
Response System ◽  
Primary Physician ◽  
Patient Consent

Purpose: An important role of the rapid response system (RRS) is to provide opportunities for end-of-life care (EOLC) decisions to be appropriately operationalized. We investigated whether EOLC decisions were made after the RRS-recommended EOLC decision to the primary physician. Materials and Methods: We studied whether patients made EOLC decisions consistent with the rapid response team’s (RRT) recommendations, between January 1, 2017, and February 28, 2019. The primary outcome was the EOLC decision after the RRT’s recommendation to the primary physician. The secondary outcome was the mechanism of EOLC decision-making: through institutional do-not-resuscitate forms or the Korean legal forms of Life-Sustaining Treatment Plan (LSTP). Results: Korean LSTPs were used in 26 of the 58 patients who selected EOLC, from among the 75 patients for whom the RRS made an EOLC recommendation. Approximately 7.2% of EOLC decisions for inpatients were related to the RRT’s interventions in EOLC decisions. Patients who made EOLC decisions did not receive cardiopulmonary resuscitation, mechanical ventilation, or dialysis. Conclusion: The timely intervention of the RRS in EOLC facilitates an objective assessment of the patient’s medical conditions, the limitation of treatments that may be minimally beneficial to the patient, and the choice of a higher quality of care. The EOLC decision using the legal process defined in the relevant Korean Act has advantages, wherein patients can clarify their preference, the family can prioritize the patient’s preference for EOLC decisions, and physicians can make transparent EOLC decisions based on medical evidence and informed patient consent.

The rapid response system and end-of-life care

2013 ◽  
Vol 19 (6) ◽  
pp. 616-623 ◽  
Author(s):  
Daryl Jones ◽  
Juli Moran ◽  
Bradford Winters ◽  
John Welch
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Rapid Response ◽  
Life Care ◽  
Rapid Response System ◽  
Response System

End of life care in the community: the role of ambulance clinicians

2013 ◽  
Vol 5 (7) ◽  
pp. 394-399 ◽  
Author(s):  
Annie Pettifer ◽  
Rosanna Bronnert
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care

scholarly journals Continuation of end-of-life care in a special elderly nursing home and the role of doctors

2012 ◽  
Vol 49 (3) ◽  
pp. 336-343
Author(s):  
Akira Kurita ◽  
Naosuke Shinagawa ◽  
Eitarou Kodani ◽  
Shinichirou Iwahara ◽  
Bonpei Takase ◽  
...  
Keyword(s):  
Nursing Home ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care

False Expectations? Expectations vs. Probabilities for Dying

2000 ◽  
Vol 41 (3) ◽  
pp. 157-185 ◽  
Author(s):  
Carolyn M. Smith
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Living Will ◽  
Ethnographic Study ◽  
Life Care ◽  
Patient Attitudes ◽  
Affected Patient ◽  
Catastrophic Illness ◽  
Physician Relationship

It is widely recognized that the role of the physician has undergone dramatic changes in the last century—changes which have serious implications for the patient-physician relationship. This is an ethnographic study examining how certain changes in the role and abilities of biomedical physicians have affected patient attitudes and expectations about end-of-life care. In-home interviews were conducted with eighteen persons age fifty-five and older, including a sample of Hemlock Society members. Results indicate a broad spectrum of end-of-life concerns including capacity, autonomy, pain, and burden to loved ones. Most participants reported a reluctance to begin a discussion of death or future deteriorating capacity with their physicians. Instead, when conversations about death were reported, they had been largely limited to the scenarios of catastrophic illness (e.g., hospitalization, ventilator, etc.) and the Living Will. While this discussion does not overlook the utility of the Living Will, it proposes that reliance on this document for preparing patients for end-of-life care is inadequate.

scholarly journals P142: Gaps in public preparedness to be a substitute decision maker and the acceptability of high school education on resuscitation and end-of-life care: a mixed-methods study

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S115-S116
Author(s):  
M. Wong ◽  
M. Medor ◽  
K. Yelle Labre ◽  
M. Jiang ◽  
J. Frank ◽  
...  
Keyword(s):  
High School ◽  
Mixed Methods ◽  
Critical Illness ◽  
End Of Life ◽  
Decision Maker ◽  
End Of Life Care ◽  
High School Education ◽  
Life Care ◽  
Substitute Decision Maker

Introduction: When a patient is incapable of making medical decisions for themselves, choices are made according to the patient's previously expressed, wishes, values, and beliefs by a substitute decision maker (SDM). While interventions to engage patients in their own advance care planning exist, little is known about public readiness to act as a SDM on behalf of a loved one. This mixed-methods survey aimed to describe attitudes, enablers and barriers to preparedness to act as a SDM, and support for a population-level curriculum on the role of an SDM in end-of-life and resuscitative care. Methods: From November 2017 to June 2018, a mixed-methods street intercept survey was conducted in Ottawa, Canada. Descriptive statistics and logistic regression analysis were used to assess predictors of preparedness to be a SDM and understand support for a high school curriculum. Responses to open-ended questions were analyzed using inductive thematic analysis. Results: The 430 respondents were mostly female (56.5%) with an average age of 33.9. Although 73.0% of respondents felt prepared to be a SDM, 41.0% of those who reported preparedness never had a meaningful conversation with loved ones about their wishes in critical illness. The only predictors of SDM preparedness were the belief that one would be a future SDM (OR 2.36 95% CI 1.34-4.17), and age 50-64 compared to age 16-17 (OR 7.46 95% CI 1.25-44.51). Thematic enablers of preparedness included an understanding of a patient's wishes, the role of the SDM and strong familial relationships. Barriers included cultural norms, family conflict, and a need for time for high stakes decisions. Most respondents (71.9%) believed that 16 year olds should learn about SDMs. They noted age appropriateness, potential developmental and societal benefit, and improved decision making, while cautioning the need for a nuanced approach respectful of different maturity levels, cultures and individual experiences. Conclusion: This study reveals a concerning gap between perceived preparedness and actions taken in preparation to be an SDM for loved ones suffering critical illness. The results also highlight the potential role for high school education to address this gap. Future studies should further explore the themes identified to inform development of resources and curricula for improved health literacy in resuscitation and end-of-life care.

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