Thursday, January 05, 2012

Rapid response teams and end-of-life care

How well are end-of-life issues dealt with in emergency situations in hospitals, i.e., when rapid response teams are called in?  Researchers in Australia, Canada, and Sweden asked that question and studied the treatment of several hundred patients over the course of a month.  Nearly one-third of patients seen by a rapid response team ultimately had limitations placed on their care (such as do-not-resuscitate orders).  This is suboptimal compared to making those plans earlier, during less stressful times.  Here is the formal conclusion published in Critical Care Medicine:

Issues around end-of-life care and limitations of medical therapy arose in approximately one-third of calls, suggesting a mismatch between patient needs for end-of-life care and resources at participating hospitals. These calls frequently occur in elderly medical patients and out of hours. Many such patients do not return home, and half die in hospital. There is a need for improved advanced care planning in our hospitals.


Thomas said...

Agree with the conclusions completely. See this all the time. Ridiculous when you think about it. We are very good at skimming the cream. Not so good at the sticky messes. This is changing, and things are improving. There are no curtains, no shutters, no silk robes any more. Everyone will be held accountable for changing impractical and obstructive behavior.

Anonymous said...

I find this conclusion frustrating. What it says to me is that individuals and PCPs are not addressing the issue and punting to the hospital.

There will never be enough money to throw at this problem if it's being addressed at the hospital end of the equation.

The main results also show that patients that had limitations placed on their care were less likely to come from home and more likely to be 80 years or older.

Tell me, why doesn't an 80 year old in a nursing home have advance directives already in place? Maybe we should really start there first.

Anonymous said...

Does that mean that around two thirds of the cases were directed to ethics or social work?

How many cases a month would this be for the U.S?

Anonymous said...

I have seen many times in a "major" city ED, the patient signed a living will with DNR, and the family insists they want "everything done" The hospitals are wary of a potential lawsuit and start the measures that the person did not want.

Anonymous said...

It is most interesting to me that these results were obtained in non-U.S. hospitals - suggesting that some of our theories about it, such as instituting 'codes' for fear of the U.S. tort system, may be in error.

nonlocal MD