ICUs receive higher satisfaction scores for end-of-life care than other hospital units

ICUs receive higher satisfaction scores for end-of-life care than other hospital units

Press releases may be edited for formatting or style | January 24, 2020 Emergency Medicine
Family caregivers of the deceased rated the quality of end-of-life care in the intensive care unit (ICU) higher than the end-of-life care in other hospital departments (also called wards), according to new, large Penn Medicine study in the American Journal of Respiratory and Critical Care Medicine. The research challenges a common belief that dying in the ICU is a less favorable experience than dying elsewhere in the hospital.

The findings don't suggest that more dying patients should be moved to the ICU, rather that more efforts should be made to learn about the elements in the ICU that potentially improve end-of-care experiences, such as higher staffing ratios. These lessons could then be applied to other clinical settings.

What's more, ICU use - often associated with unfavorable end-of-life experiences by clinicians, researchers, and policymakers - may not be an appropriate measure of poor quality end-of-life care.

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"It has been assumed that dying in an ICU is even worse than a ward because it's more expensive and more intensive. But that has been never been based on any sound evidence - it's just based on traditional ways of looking at the problem," said senior author Scott D. Halpern, MD, PhD, a critical care physician and professor of Medicine, Epidemiology, and Medical Ethics and Health Policy in Penn's Perelman School of Medicine, and director of the Palliative and Advanced Illness Research (PAIR) Center. "So, we wanted to better understand the difference in the care. Are the doctors getting it right? Are the researchers getting it right? Are policymakers getting it right? Turns out, none of those parties were getting it right."

The study analyzed clinical data and bereavement surveys from the family members of more than 28,000 patients who died in 106 Veterans Administration (VA) acute-care hospitals between 2010 and 2016 in and outside the ICU, including those who experienced care in both.

Compared with ward-based care, the researchers found ICU care was associated with higher ratings by family caregivers of overall care, pain management, clinician-family communication, emotional support, and spiritual support during patients' final 30 days.

Reducing ICU use has been a longstanding research and policy objective. In many surveys, ICU care has received lower ratings for cancer patients, likely because they underwent aggressive treatments. Driven by this and other factors, researchers have used ICU deaths as an outcome measure in their studies, with the idea that lower rates of ICU death represent better end-of-life care. Policymakers have also clung to this notion, with some pushing for ICU utilization as a measure of low-quality care - a move that could adversely affect hospital patient and safety scores. However, few studies exist to support this view.

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