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In the U.S., 10% to 20% of patients admitted to an intensive care unit (ICU) will die in the ICU. Many critical care teams have partnered with palliative care providers to deliver outstanding end-of-life care in the ICU. However, transitioning critically ill patients from the ICU to hospice care is relatively rare. In this study, investigators retrospectively examined a program in which patients were transferred from an ICU to an inpatient hospice unit (IHU) in two academic medical centers within the same healthcare system.
During 6 months, 167 patients were transferred from the ICU to the IHU; 99 missed opportunities for transfer also were identified. Patients who were not transferred were less likely to have received palliative care consultations and more likely to have required mechanical ventilation or vasopressors, although IHU admission criteria did not exclude such interventions. An estimated 585 ICU days might have been avoided if all opportunities for transfer were realized.
Binney ZO et al. Feasibility and economic impact of dedicated hospice inpatient units for terminally ill ICU patients. Crit Care Med 2014 May; 42:1074. (http://dx.doi.org/10.1097/CCM.0000000000000120)
Comment
Collaboration between palliative care and critical care providers has yielded progressively nuanced end-of-life care in the ICU. Transition to inpatient hospice care might confer added benefit, because hospice provides resources that rarely are available in an ICU, including prolonged bereavement support for families. Although we need to examine the long-term effect of ICU-to-hospice transfers, they clearly are feasible and might improve patient and family care as well as lower hospital costs.