Delivery of end‐of‐life care in an emergency department–based intensive care unit

• Published in: Journal of the American College of Emergency Physicians Open 2020-12, Vol.1 (6), p.1500-1504
• Main Authors: Leith, Thomas B., Haas, Nathan L., Harvey, Carrie E., Chen, Cynthia, Ives Tallman, Crystal, Bassin, Benjamin S.
• Format: Article
• Language: English
• Subjects: ED‐ICU; end of life; Original Research; Palliative Care
• ISSN: 2688-1152; 2688-1152
• DOI: 10.1002/emp2.12258

Objective Intensive care unit (ICU) admissions near the end of life have been associated with worse quality of life and burdensome costs. Patients may not benefit from ICU admission if appropriate end‐of‐life care can be delivered elsewhere. The objective of this study was to descriptively analyze patients receiving end‐of‐life care in an emergency department (ED)–based ICU (ED‐ICU). Methods This is a retrospective analysis of patient outcomes and resource use in adult patients receiving end‐of‐life care in an ED‐ICU. In 2015, an “End of Life” order set was created to standardize delivery of palliative therapies and comfort measures. We identified adult patients (>18 years) receiving end‐of‐life care in the ED‐ICU from December 2015 to March 2020 whose clinicians used the end‐of‐life order set. Results A total of 218 patients were included for analysis; 50.5% were female, and the median age was 73.6 years. The median ED‐ICU length of stay was 13.3 hours (interquartile range, 7.4–20.6). Two patients (0.9%) were admitted to an inpatient ICU, 117 (53.7%) died in the ED‐ICU, 77 (35.3%) were admitted to a non–intensive care inpatient service, and 22 (10.1%) were discharged from the ED‐ICU. Conclusions An ED‐ICU can be used for ED patients near the end of life. Only 0.9% were subsequently admitted to an ICU, and 10.1% were discharged from the ED‐ICU. This practice may benefit patients and families by avoiding costly ICU admissions and benefit health systems by reducing ICU capacity strain.