Assessment of End of Life Practices in a 53 Bed Oncologic Intensive Care Unit
Haque, SA; Joshi, V; Erfe, R; Price KJ; Nates, JL; Rathi, N
The University of Texas M. D. Anderson Cancer Center
Annually, the cost of treating intensive care unit (ICU) patients approaches $180,000,000,000 in America. Timely end of life (EOL) decision-making is crucial to minimize patient suffering and limit costs.
This study examines when EOL decisions are made and which health care providers are making these decisions.
All admissions to our Medical ICU (MICU) over an 18 month period were retrospectively reviewed. The number of admissions admitted to the ICU with a do-not-resuscitate (DNR) or comfort care (CC) status, the number made DNR or CC during their ICU stay, and the number whose code status changed during the first 24 and 48 hours of ICU admission were determined. Time to change and involved provider were also noted.
Among 2231 admissions to the MICU during the study period, 13 patients came with a DNR status and 813 were made DNR during their ICU stay. Of these, 439 cases changed code status within 24 hours and 540 within 48 hours of admission. The critical care team was responsible for 56.3% of the DNR status changes. No patients came to the ICU with a CC status. A total of 395 were made comfort care during their ICU stay; 39 cases within 24 hours and 110 within 48 hours of ICU admission. The critical care team was responsible for transition to CC in 90.1%.
Changes in code status are frequently made within a day of ICU admission, suggesting that EOL decision making earlier in the hospital stay may decrease patient suffering and unnecessary healthcare costs.