Experience of providing palliative care in critical care settings

Background Changing demographics and medical advances have led to an increased demand for beds in critical care units. Patients in critical care are at risk of physical and psychosocial suffering. The goal of palliative care is to achieve the best quality of life for patients and families irrespective of diagnosis or location of care. The delivery of high-quality end-of-life care in critical care units can be challenging. Objectives Our aim was to (1) identify patient characteristics and timing of referral to Hospital Palliative Care Team (HPCT) since admission to critical care unit; (2) assess the impact of HPCT on patient care and location of death; (3) describe challenges of providing input in this setting by HPCT. Methods We retrospectively reviewed all referrals to HPCT from critical care units of a large teaching hospital over a 6-year period. Data were extracted from an electronic database storing details of all patient referrals and contacts. Results As a proportion of all referrals to HPCT, those from critical care rose from 1.7% to 3.17%. The proportion of patients with nonmalignant diagnoses referred has risen from 29% to 39%. Of total referrals, 96/ 144 (66.6%) patients died within the same episode of care. 65% of these died within 1 week. 51% of patients died on critical care. We also describe challenges encountered and impact of the HPCT on patient care. Conclusions The HPCT provide an important contribution to patients in critical care, through symptom control, family support, continuity of care and in end-of-life care. On the basis of our review, the challenge is to move from a sequential model of care to a more integrated approach.