Faculty Opinions recommendation of Doctors' and nurses' views and experience of transferring patients from critical care home to die: a qualitative exploratory study.

2015 ◽  
Author(s):  
Thomas J Papadimos
Keyword(s):  
Critical Care ◽  
Exploratory Study ◽  
Care Home ◽  
Doctors And Nurses

scholarly journals Doctors’ and nurses’ views and experience of transferring patients from critical care home to die: A qualitative exploratory study

2014 ◽  
Vol 29 (4) ◽  
pp. 354-362 ◽  
Author(s):  
Maureen Coombs ◽  
Tracy Long-Sutehall ◽  
Anne-Sophie Darlington ◽  
Alison Richardson
Keyword(s):  
Critical Care ◽  
United Kingdom ◽  
End Of Life ◽  
Health Care Professionals ◽  
Care Home ◽  
Rare Event ◽  
Community Services ◽  
Critical Care Units ◽  
The United Kingdom ◽  
Doctors And Nurses

Background: Dying patients would prefer to die at home, and therefore a goal of end-of-life care is to offer choice regarding where patients die. However, whether it is feasible to offer this option to patients within critical care units and whether teams are willing to consider this option has gained limited exploration internationally. Aim: To examine current experiences of, practices in and views towards transferring patients in critical care settings home to die. Design: Exploratory two-stage qualitative study Setting/participants: Six focus groups were held with doctors and nurses from four intensive care units across two large hospital sites in England, general practitioners and community nurses from one community service in the south of England and members of a Patient and Public Forum. A further 15 nurses and 6 consultants from critical care units across the United Kingdom participated in follow-on telephone interviews. Findings: The practice of transferring critically ill patients home to die is a rare event in the United Kingdom, despite the positive view of health care professionals. Challenges to service provision include patient care needs, uncertain time to death and the view that transfer to community services is a complex, highly time-dependent undertaking. Conclusion: There are evidenced individual and policy drivers promoting high-quality care for all adults approaching the end of life encompassing preferred place of death. While there is evidence of this choice being honoured and delivered for some of the critical care population, it remains debatable whether this will become a conventional practice in end of life in this setting.

scholarly journals A national survey exploring views and experience of health professionals about transferring patients from critical care home to die

2015 ◽  
Vol 29 (4) ◽  
pp. 363-370 ◽  
Author(s):  
Anne-Sophie E. Darlington ◽  
Tracy Long-Sutehall ◽  
Alison Richardson ◽  
Maureen A. Coombs
Keyword(s):  
Critical Care ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Care Home ◽  
Professional Role ◽  
National Study ◽  
Web Based ◽  
Critical Care Units ◽  
The United Kingdom ◽  
Doctors And Nurses

Background: Transferring critically ill patients home to die is poorly explored in the literature to date. This practice is rare, and there is a need to understand health care professionals’ (HCP) experience and views. Objectives: To examine (1) HCPs’ experience of transferring patients home to die from critical care, (2) HCPs’ views about transfer and (3) characteristics of patients, HCPs would hypothetically consider transferring home to die. Design: A national study developing a web-based survey, which was sent to the lead doctors and nurses in critical care units. Setting/participants: Lead doctors and senior nurses (756 individuals) working in 409 critical care units across the United Kingdom were invited to participate in the survey. Results: In total, 180 (23.8%) completed surveys were received. A total of 65 (36.1%) respondents had been actively involved in transferring patients home to die and 28 (15.5%) had been involved in discussions that did not lead to transfer. Respondents were supportive of the idea of transfer home to die (88.8%). Patients identified by respondents as unsuitable for transfer included unstable patients (61.8%), intubated and ventilated patients (68.5%) and patients receiving inotropes (65.7%). There were statistically significant differences in views between those with and without experience and between doctors and nurses. Nurses and those with experience tended to have more positive views. Conclusion: While transferring patients home to die is supported in critical care, its frequency in practice remains low. Patient stability and level of intervention are important factors in decision-making in this area. Views held about this practice are influenced by previous experience and the professional role held.

scholarly journals Paediatric admissions to a district general hospital adult intensive care unit over a six year period: A single centre retrospective case series, with review of practitioner confidence and competence in paediatric critical care

2021 ◽  
pp. 175114372110121
Author(s):  
Stephen A Spencer ◽  
Joanna S Gumley ◽  
Marcin Pachucki
Keyword(s):  
Critical Care ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Case Series ◽  
Critically Ill Children ◽  
Single Centre ◽  
Retrospective Case ◽  
Retrospective Case Series ◽  
Paediatric Critical Care ◽  
Doctors And Nurses

Background Critically ill children presenting to district general hospitals (DGH) are admitted to adult intensive care units (AICUs) for stabilisation prior to transfer to paediatric intensive care units (PICUs). Current training in PICU for adult intensive care physicians is only three months. This single centre retrospective case series examines the case mix of children presenting to a DGH AICU and a multidisciplinary survey assesses confidence and previous experience, highlighting continued training needs for DGH AICU staff. Methods all paediatric admissions to AICU and paediatric retrievals were reviewed over a 6-year period (2014-2019). Cases were identified from the Electronic Patient Record (EPR) and from data provided by the regional paediatric retrieval service. A questionnaire survey was sent to AICU doctors and nurses to assess confidence and competence in paediatric critical care. Results Between 2014-2019, 284 children were managed by AICU. In total 35% of cases were <1 y, 48% of cases were <2 y and 64% of cases were <5 y, and 166/284 (58%) children were retrieved. Retrieval reduced with increasing age (OR 0.49 [0.40-0.60], p < 0.0001). The survey had an 82% response rate, and highlighted that only 13% of AICU nurses and 50% of doctors had received prior PICU training. Conclusion At least one critically unwell child presents to the AICU each week. Assessment, stabilisation and management of critically unwell children are vital skills for DGH AICU staff, but confidence and competence are lacking. Formalised strategies are required to develop and maintain paediatric competencies for AICU doctors and nurses.

scholarly journals Exploratory study of staff perceptions of shift safety in the critical care unit and routinely available data on workforce, patient and organisational factors

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e034101
Author(s):  
Clare Leon-Villapalos ◽  
Mary Wells ◽  
Stephen Brett
Keyword(s):  
Critical Care ◽  
Work Environment ◽  
Exploratory Study ◽  
Routine Data ◽  
Care Staff ◽  
Staff Perceptions ◽  
Large Teaching Hospital ◽  
Level 3 ◽  
Perceptions Of Safety ◽  
Organisational Factors

ObjectivesTo explore bedside professional reported (BPR) perceptions of safety in intensive care staff and the relationships between BPR safety, staffing, patient and work environment characteristics.DesignAn exploratory study of self-recorded staff perceptions of shift safety and routinely collected data.SettingA large teaching hospital comprising 70 critical care beds.ParticipantsAll clinical staff working in adult critical care.InterventionsStaff recorded whether their shift felt ‘safe, unsafe or very unsafe’ for 29 consecutive days. We explored these perceptions and relationships between them and routine data on staffing, patient and environmental characteristics.Outcome measuresRelationships between BPR safety and staffing, patient and work environment characteristics.Results2836 BPR scores were recorded over 29 consecutive days (response rate 57.7%). Perceptions of safety varied between staff, including within the same shift. There was no correlation between perceptions of safety and two measures of staffing: care hours per patient day (r=0.13 p=0.108) and Safecare Allocate (r=−0.19 p=0.013). We found a significant, positive relationship between perceptions of safety and the percentage of level 3 (most severely ill) patients (r=0.32, p=0.0001). There was a significant inverse relationship between perceptions of safety and the percentage of level 1 patients on a shift (r=−0.42, p<0.0001). Perceptions of safety correlated negatively with increased numbers of patients (r=−0.44, p=0.0006) and higher percentage of patients located side rooms (r=0.63, p<0.0001). We found a significant relationship between perceptions of safety and the percentage of staff with a specialist critical care course (r=0.42. p=0.0001).ConclusionExisting staffing models, which are primarily influenced by staff-to-patient ratios, may not be sensitive to patient need. Other factors may be important drivers of staff perceptions of safety and should be explored further.

scholarly journals Clinical bleeding and thrombin generation in admissions to critical care with prolonged prothrombin time: an exploratory study

Transfusion ◽  
2018 ◽  
Vol 58 (6) ◽  
pp. 1388-1398 ◽  
Author(s):  
Simon J. Stanworth ◽  
Michael J.R. Desborough ◽  
Gemma Simons ◽  
Frances Seeney ◽  
Gillian Powter ◽  
...  
Keyword(s):  
Critical Care ◽  
Prothrombin Time ◽  
Exploratory Study ◽  
Thrombin Generation ◽  
Prolonged Prothrombin Time

Pediatric Cardiac Critical Care Transport and Palliative Care: A Case Series

2020 ◽  
Vol 38 (1) ◽  
pp. 94-97
Author(s):  
Xiomara Garcia ◽  
Elizabeth Frazier ◽  
Janie Kane ◽  
Amber Jones ◽  
Carrie Brown ◽  
...  
Keyword(s):  
Palliative Care ◽  
Critical Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Support ◽  
Care Home ◽  
Case Series ◽  
Life Care ◽  
Cardiac Critical Care ◽  
At Home

Objective: To present our center’s experience with terminal extubation in 3 palliative critical care home transports from the Pediatric Cardiac Intensive Unit. Design: All cases were identified from our Cardiovascular intensive care unit ( CVICU). Patients were terminally ill children with no other surgical or medical option who were transported home between 2014 and 2018, for terminal extubation and end-of-life care according to their families’ wishes. Interventions: The patients were 7, 9 months, and 19 years; and they had very complex and chronic conditions. The families were approached by the CVICU staff during multidisciplinary meetings, where goals of care were established. Parental expectations were clarified, and palliative care team was involved, as well as home hospice was arranged pre transfer. The transfer process was discussed and all the needs were established. All patients had unstable medical conditions, with needs for transport for withdrawal of life support and death at home. Each case needed a highly trained team to support life while in transport. The need of these patients required coordination with home palliative care services, as well as community resources due to difficulty to get in their homes. Conclusions: Transportation of pediatric cardiac critical care patients for terminal extubation at home is a relatively infrequent practice. It is a feasible alternative for families seeking out of the hospital end-of-life care for their critically ill and technology dependent children. Our single-center experience supports the need for development of formal programs for end-of-life critical care transports.

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