More Australians die in hospital than any other setting. In an acute private hospital setting with no specialist palliative care inpatient beds, Intensive Care Unit (ICU) personnel are involved in end-of-life (EOL) care planning and decision-making.
The aim was to measure the quality of EOL care against Standard Five: Comprehensive Care of the National Standards, according to the type of involvement of ICU personnel.
A retrospective medical record audit of adult deaths was conducted, using twenty data items, considered representative of quality EOL care, mapped against Standard Five. The deceased patient sample were separated into three cohorts for comparison.
Of the 297 deceased patients in the sample, 35.6% (n=106) were admitted to the ICU, 30.0% (n=89) received ICU outreach care, and 34.3% (n=102) had no ICU involvement. The Median age was 81 years (IQR=16, 25th–75th percentile=72-88). 45.1% (n=134) had a cancer diagnosis, 77.1% (n=229) were admitted under a medical specialty, and 87.5% (n=260) had a valid not-for-resuscitation order.
ICU personnel were involved in 65.7% (n=195) cases. EOL care quality was highest for those with no ICU involvement (Mdn=17, IQR=3, 15-18) and lowest for those admitted to the ICU (Mdn=15, IQR=4, 12-16), (p<.001). 52.5% (n=156) of patients were reviewed by specialist palliative care personnel; least likely in the ICU admission cohort (n=42, 39.6%), and most likely in those with no ICU involvement (n=72, 70.6%). Religious support was offered in 65.3% (n=194) cases. After death, evidence of an offer of bereavement follow-up for families was low across all cohorts (11.5%, n=34), and least likely for those admitted to the ICU (6.6%, n=7).
Whilst EOL care was provided in accordance with Standard Five, there was significant variation in care overall, in particular, when ICU personnel were involved. Specialist palliative care review services were underutilised, likely contributing to the high level of involvement of ICU personnel.
If ICU personnel are to be involved in EOL care within and outside of ICU, further work is needed to increase specialist palliative care involvement and collaboration with ICU personnel to ensure the provision of high-quality EOL care.