1
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Sudunagunta V, Singh N, Khan P, Beaumont PO. End of life care at home: The role of critical care transfer services. J Intensive Care Soc 2024; 25:237-241. [PMID: 38737303 PMCID: PMC11086710 DOI: 10.1177/17511437231217878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Most people would rather die at home than in hospital but only 18% of patients do so. Palliative care focuses on the physical, spiritual and psychosocial wellbeing of patients and their families, which should include facilitating transfers home when possible. Patients can have more autonomy over their care and be surrounded by loved ones which can have a significant impact on their quality of life. In this article we describe two cases of home repatriation for palliation. Case 1 describes the transfer of a patient with difficulties and gaps in planning, but with a safe transfer ultimately. Case 2 recounts a more comprehensive planning process emphasising collaboration between teams. Benefits and difficulties of palliative critical care transfers Facilitating home-based care aligns with patients' desires for familiar surroundings and emotional support. A secondary benefit is that releasing a bed space allows another patient to receive critical care treatment. Challenges of palliative critical care transfers include needing a highly trained team and thorough planning. Early discussion with the family and community palliative care teams makes this a more feasible option for patients. Conclusion A multidisciplinary team of hospital and community healthcare professionals working with the patient and their family can facilitate the transfer from intensive care to allow them to die at a place of their choosing. We should aim to fulfil these wishes at the end of life as it can greatly improve the patient's and their family's physical and emotional wellbeing during this difficult time.
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Affiliation(s)
| | - Neeraj Singh
- Kings College Hospital NHS Foundation Trust, London, UK
| | - Pervez Khan
- Kings College Hospital NHS Foundation Trust, London, UK
- Specialist Retrieval & Intensive Care Transfer Service, London, UK
| | - Peter O Beaumont
- Kings College Hospital NHS Foundation Trust, London, UK
- Specialist Retrieval & Intensive Care Transfer Service, London, UK
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2
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Swasey H, Morrill D, Mott S, Engstrand S, Connor JA. Perceptions of Interprofessional Practitioners Regarding Pediatric Palliative Transports. Am J Crit Care 2024; 33:133-139. [PMID: 38424020 DOI: 10.4037/ajcc2024127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
BACKGROUND Pediatric palliative transport (PPT) is the practice of offering critically and terminally ill children requiring life-sustaining measures the opportunity to be discharged from the hospital to home or a hospice facility for end-of-life care. Although studies have shown PPT to favorably affect both children and their families, limited research exists on the perspectives of health care practitioners. OBJECTIVES To understand the experience of interprofessional practitioners who have cared for a critically or terminally ill child during a PPT and their perception of PPT as a care option. METHODS This study is a qualitative descriptive inquiry conducted using 8 focus groups. Participants included interprofessional staff from 4 specialty intensive care units, the pediatric advanced care team, and the critical care transport team at a quaternary, freestanding children's hospital. Content analysis was used to summarize themes and recommendations. RESULTS Five overarching themes were identified: PPT as a care pathway, education, communication, support, and closure. Use of PPT was perceived as aligned with the hospital's mission of family-centered care and as providing a way for the health care team to support a family's choice. Participants recommended further development of information to guide communication and processes of care that would enhance the experience for families and staff and support PPT as a care pathway. CONCLUSIONS Pediatric palliative transport is considered a feasible, valuable, and critical end-of-life intervention. The value that PPT has brought to participating families warrants continued investment in the intervention's standardization and enhancement.
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Affiliation(s)
- Harriett Swasey
- Harriett Swasey is a staff nurse, Critical Care Transport Team, Boston Children's Hospital, Boston, Massachusetts
| | - Diana Morrill
- Diana Morrill is a project coordinator, Cardiovascular, Critical Care, and Perioperative Patient Services, Boston Children's Hospital, Boston, Massachusetts
| | - Sandra Mott
- Sandra Mott is a nurse scientist, Cardiovascular and Critical Care Patient Services, Boston Children's Hospital, Boston, Massachusetts
| | - Shannon Engstrand
- Shannon Engstrand is a project coordinator, Cardiovascular, Critical Care, and Perioperative Patient Services, Boston Children's Hospital, Boston, Massachusetts
| | - Jean Anne Connor
- Jean Anne Connor is the director of nursing research, Cardiovascular, Critical Care, and Perioperative Patient Services, Boston Children's Hospital, Boston, Massachusetts, and an assistant professor of Pediatrics, Harvard Medical School, Boston, Massachusetts
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3
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Walker M, Nicolardi D, Christopoulos T, Ross T. Hospital, hospice, or home: A scoping review of the importance of place in pediatric palliative care. Palliat Support Care 2023; 21:925-934. [PMID: 37357946 DOI: 10.1017/s1478951523000664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
BACKGROUND Palliative care necessitates questions about the preferred place for delivering care and location of death. Place is integral to palliative care, as it can impact proximity to family, available resources/support, and patient comfort. Despite the importance of place, there is remarkably little literature exploring its role in pediatric palliative care (PPC). OBJECTIVES To understand the importance and meaning of place in PPC. METHODS We conducted a scoping review to understand the importance of place in PPC. Five databases were searched using keywords related to "pediatric," "palliative," and "place." Two reviewers screened results, extracted data, and analyzed emergent themes pertaining to place. RESULTS From 3076 search results, we identified and reviewed 25 articles. The literature highlights hospital, home, and hospice as 3 distinct PPC places. Children and their families have place preferences for PPC and place of death, and a growing number prefer death to occur at home. Results also indicate numerous factors influence place preferences (e.g., comfort, grief, cultural/spiritual practices, and socioeconomic status). SIGNIFICANCE OF RESULTS Place influences families' PPC decisions and experiences and thus warrants further study. Greater understanding of the importance and roles of place in PPC could enhance PPC policy and practice, as well as PPC environments.
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Affiliation(s)
- Meaghan Walker
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Danielle Nicolardi
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Téa Christopoulos
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Timothy Ross
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
- Department of Geography & Planning, University of Toronto, Toronto, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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4
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Sibley S, Buller-Hayes L, Ross G. Palliation in a pandemic. CMAJ 2021; 193:E1925-E1926. [PMID: 34930771 PMCID: PMC8687515 DOI: 10.1503/cmaj.211210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Stephanie Sibley
- Department of Critical Care Medicine, Kingston Health Sciences Centre, Kingston, Ont
| | - Leslie Buller-Hayes
- Department of Critical Care Medicine, Kingston Health Sciences Centre, Kingston, Ont
| | - Graeme Ross
- Department of Critical Care Medicine, Kingston Health Sciences Centre, Kingston, Ont
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5
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Millán García Del Real N, Sánchez García L, Ballesteros Diez Y, Rodríguez Merlo R, Salas Ballestín A, Jordán Lucas R, de Lucas García N. Importance of specialized paediatric and neonatal transport. Current situation in Spain: Towards a more equitable and universal future. An Pediatr (Barc) 2021; 95:485.e1-485.e10. [PMID: 34857500 DOI: 10.1016/j.anpede.2021.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 12/01/2022] Open
Abstract
Specialized paediatric and neonatal transport is a useful and essential resource in the interhospital transfer of these patients. It allows bringing the material and personal resources of an intensive care unit closer to the regional hospitals where the patient can be found. The benefits of these teams are very well demonstrated in the literature. These units should be part of the emergency systems, while it would be recommended that they be staff integrated in the tertiary hospitals, in order to maintain the necessary skills and competencies. The team, made up of physicians, nurses and emergency medical technicians, must master both the pathophysiology of transport and that of the critical patient in this age range. A high quality of both human and care is important, so continuous training and periodic recycling will be essential to be compliant with the quality indicators in transport. Likewise, it is essential to have specific vehicles adapted to this function, which allow carrying the wide variety of necessary material, as well as the electromedicine that is required. However, in Spain this paediatric and neonatal transport model is not standardized and therefore is not homogeneous: there are different models that do not always provide adequate quality, making it necessary to implement specialized units throughout the country to guarantee sanitary transport quality to any critical child or neonate.
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Affiliation(s)
- Nuria Millán García Del Real
- Servicio de Emergencias Médicas Pediátricas, Cataluña, Spain; Unidad de Cuidados Intensivos Pediátricos, Hospital San Juan de Dios, Cataluña, Spain; Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP).
| | - Laura Sánchez García
- Servicio de Neonatología del Hospital Universitario La Paz, Madrid, Spain; Equipo de Transporte Neonatal de la Comunidad de Madrid, Madrid, Spain; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología, Spain
| | - Yolanda Ballesteros Diez
- Servicio de Urgencias del Hospital Universitario Cruces, Bilbao, Spain; Grupo de trabajo de Paciente Crítico de la Sociedad Española de Urgencias de Pediatría
| | - Raquel Rodríguez Merlo
- SUMMA112 Madrid, Madrid, Spain; Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias
| | - Alberto Salas Ballestín
- Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP); Unidad de Transporte Pediátrico de Baleares, Islas Baleares, Spain; Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Raquerl Jordán Lucas
- Servicio de Neonatología del Hospital Universitari Vall d'Hebron, Barcelona, Spain; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología
| | - Nieves de Lucas García
- Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias; SAMUR-Protección Civil de Madrid, Madrid, Spain
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6
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Millán García Del Real N, Sánchez García L, Ballesteros Diez Y, Rodríguez Merlo R, Salas Ballestín A, Jordán Lucas R, de Lucas García N. [Importance of specialized paediatric and neonatal transport. Current situation in Spain: Towards a more equitable and universal future]. An Pediatr (Barc) 2021; 95:S1695-4033(21)00221-6. [PMID: 34304986 DOI: 10.1016/j.anpedi.2021.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
Specialized paediatric and neonatal transport is a useful and essential resource in the interhospital transfer of these patients. It allows bringing the material and personal resources of an intensive care unit closer to the regional hospitals where the patient can be found. The benefits of these teams are very well demonstrated in the literature. These units should be part of the emergency systems, while it would be recommended that they would be staff integrated in the tertiary hospitals, in order to maintain the necessary skills and competencies. The team, made up of physicians, nurses and emergency medical technicians, must master both the pathophysiology of transport and that of the critical patient in this age range. A high-quality of both human and care is important, so continuous training and periodic recycling will be essential to be compliant with the quality indicators in transport. Likewise, it is essential to have specific vehicles adapted to this function, which allow carrying the wide variety of necessary material, as well as the electromedicine that is required. However, in Spain this paediatric and neonatal transport model is not standardized and, therefore, is not homogeneous: there are different models that do not always provide adequate quality, making it necessary to implement specialized units throughout the country to guarantee sanitary transport quality to any critical child or neonate.
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Affiliation(s)
- Nuria Millán García Del Real
- Servicio de Emergencias Médicas Pediátricas, Cataluña, España; Unidad de Cuidados Intensivos Pediátricos, Hospital San Juan de Dios, Cataluña, España; Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP).
| | - Laura Sánchez García
- Servicio de Neonatología del Hospital Universitario La Paz, Madrid, España; Equipo de Transporte Neonatal de la Comunidad de Madrid, Madrid, España; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología, España
| | - Yolanda Ballesteros Diez
- Servicio de Urgencias del Hospital Universitario Cruces, Bilbao, España; Grupo de trabajo de Paciente Crítico de la Sociedad Española de Urgencias de Pediatría
| | - Raquel Rodríguez Merlo
- SUMMA112 Madrid, Madrid, España; Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias
| | - Alberto Salas Ballestín
- Grupo de Estabilización y Transporte del Niño y Neonato Crítico de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP); Unidad de Transporte Pediátrico de Baleares, Islas Baleares, España; Unidad de Cuidados Intensivos Pediátricos del Hospital Universitario Son Espases, Palma de Mallorca, España
| | - Raquel Jordán Lucas
- Servicio de Neonatología del Hospital Universitari Vall d'Hebron, Barcelona, España; Grupo de Transporte Neonatal de la Sociedad Española de Neonatología
| | - Nieves de Lucas García
- Grupo de Emergencias y Urgencias Pediátricas de la Sociedad Española de Medicina de Emergencias; SAMUR-Protección Civil de Madrid, Madrid, España
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7
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Woodruff AG, Bingham SB, Jarrah RJ, Bass AL, Nageswaran S. A Framework for Pediatric Intensivists Providing Compassionate Extubation at Home. Pediatr Crit Care Med 2021; 22:454-461. [PMID: 33443980 DOI: 10.1097/pcc.0000000000002655] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For families facing end-of-life decisions for their critically ill children, compassionate extubation at home is a valuable service that pediatric intensivists can provide. Compassionate extubation at home is resource intensive and can be logistically challenging. Discouragingly, guidance on compassionate extubation at home in the literature is limited. We developed an evidence- and experience-based framework for compassionate extubation at home addressing common planning challenges and resource management. Our objective is to share this framework and an accompanying checklist, so that pediatric intensivists in other institutions can adapt these tools for their use, reducing barriers to providing compassionate extubation at home for critically ill children at the end of life.
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Affiliation(s)
- Alan G Woodruff
- Department of Anesthesiology, Section of Pediatric Critical Care, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sarah B Bingham
- Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, NC
| | - Rima J Jarrah
- Department of Anesthesiology, Section of Pediatric Critical Care, Wake Forest School of Medicine, Winston-Salem, NC
- Department of Emergency Medicine, Brenner Children's Hospital, Pediatric Critical Care Transport, Winston-Salem, NC
| | - Andora L Bass
- Department of Anesthesiology, Section of Pediatric Critical Care, Wake Forest School of Medicine, Winston-Salem, NC
| | - Savithri Nageswaran
- Department of Pediatrics, Section of Pediatric Palliative and Complex Care, Wake Forest School of Medicine, Winston-Salem, NC
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8
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Crispo MM, Strout TD, Munzig LM, Lerwick PA. A "Good Death" During Coronavirus Disease 2019: Outdoor Terminal Extubation Facilitates Safe Family Presence for a Dying Patient. J Pain Symptom Manage 2021; 61:e20-e22. [PMID: 33137421 PMCID: PMC7604129 DOI: 10.1016/j.jpainsymman.2020.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 11/25/2022]
Affiliation(s)
| | - Tania D Strout
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | | | - Patricia A Lerwick
- Tufts University School of Medicine, Boston, Massachusetts, USA; Maine Medical Center, Portland, Maine, USA
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9
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Affonseca CDA, Carvalho LFAD, Quinet RDPB, Guimarães MCDC, Cury VF, Rotta AT. Palliative extubation: five-year experience in a pediatric hospital. J Pediatr (Rio J) 2020; 96:652-659. [PMID: 31493370 PMCID: PMC9432159 DOI: 10.1016/j.jped.2019.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/13/2019] [Accepted: 07/15/2019] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To present the characteristics of pediatric patients with chronic and irreversible diseases submitted to palliative extubation. METHOD This is a descriptive analysis of a series of patients admitted to a public pediatric hospital, with chronic and irreversible diseases, permanently dependent on ventilatory support, who underwent palliative extubation between April 2014 and May 2019. The following information was collected from the medical records: demographic data, diagnosis, duration and type of mechanical ventilation; date, time, and place of palliative extubation; medications used; symptoms observed; and hospital outcome. RESULTS A total of 19 patients with a mean age of 2.2 years were submitted to palliative extubation. 68.4% of extubations were performed in the ICU; 11 patients (57.9%) died in the hospital. The time between mechanical ventilation withdrawal and in-hospital death ranged from 15minutes to five days. Thirteen patients used an orotracheal tube and the others used tracheostomy. The main symptoms were dyspnea and pain, and the main drugs used to control symptoms were opioids and benzodiazepines. CONCLUSIONS It was not possible to identify predictors of in-hospital death after ventilatory support withdrawal. Palliative extubation requires specialized care, with the presence and availability of a multidisciplinary team with adequate training in symptom control and palliative care.
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Affiliation(s)
- Carolina de Araújo Affonseca
- Hospital Infantil João Paulo II, Unidade CUIDAR - Cuidado Paliativo e Atenção Domiciliar, Belo Horizonte, MG, Brazil.
| | | | | | | | | | - Alexandre Tellechea Rotta
- Duke University School of Medicine, Division of Pediatric Critical Care Medicine, North Carolina, United States
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10
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de Araújo Affonseca C, de Carvalho LFA, de Pinho Barroso Quinet R, da Cunha Guimarães MC, Cury VF, Rotta AT. Palliative extubation: five‐year experience in a pediatric hospital. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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Garcia X, Frazier E, Kane J, Jones A, Brown C, Bryant T, Prodhan P. Pediatric Cardiac Critical Care Transport and Palliative Care: A Case Series. Am J Hosp Palliat Care 2020; 38:94-97. [PMID: 32462881 DOI: 10.1177/1049909120928280] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To present our center's experience with terminal extubation in 3 palliative critical care home transports from the Pediatric Cardiac Intensive Unit. DESIGN All cases were identified from our Cardiovascular intensive care unit ( CVICU). Patients were terminally ill children with no other surgical or medical option who were transported home between 2014 and 2018, for terminal extubation and end-of-life care according to their families' wishes. INTERVENTIONS The patients were 7, 9 months, and 19 years; and they had very complex and chronic conditions. The families were approached by the CVICU staff during multidisciplinary meetings, where goals of care were established. Parental expectations were clarified, and palliative care team was involved, as well as home hospice was arranged pre transfer. The transfer process was discussed and all the needs were established. All patients had unstable medical conditions, with needs for transport for withdrawal of life support and death at home. Each case needed a highly trained team to support life while in transport. The need of these patients required coordination with home palliative care services, as well as community resources due to difficulty to get in their homes. CONCLUSIONS Transportation of pediatric cardiac critical care patients for terminal extubation at home is a relatively infrequent practice. It is a feasible alternative for families seeking out of the hospital end-of-life care for their critically ill and technology dependent children. Our single-center experience supports the need for development of formal programs for end-of-life critical care transports.
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Affiliation(s)
- Xiomara Garcia
- Pediatric Cardiology, Pediatric Critical Care, 3342University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Elizabeth Frazier
- Pediatric Cardiology, Pediatric Critical Care, 3342University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Janie Kane
- Pediatric Cardiology, Pediatric Critical Care, 3342University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Amber Jones
- Pediatric Cardiology, Pediatric Critical Care, 3342University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Carrie Brown
- Palliative Care, Department of Pediatrics, University of Arkansas for Medical Sciences, 14423Arkansas Children's Hospital, Little Rock, AR, USA
| | - Tonja Bryant
- Pediatric Cardiology, Pediatric Critical Care, 3342University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
| | - Parthak Prodhan
- Pediatric Cardiology, Pediatric Critical Care, 3342University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA
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12
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Raed M, Grossoehme DH, Brown M, Friebert S. Hospital to home transport at end of life: Survey of clinician experience. Palliat Med 2020; 34:424-429. [PMID: 31431157 DOI: 10.1177/0269216319870641] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative transport is transport home of patients requiring critical care transport support with expectation of imminent death. Many parents prefer their child's death at home; evidence suggests death in the preferred location improves bereavement outcomes. Little is known about the clinical and demographic diversity of patients receiving palliative transport or the perspectives of participating staff. AIM The objectives of the present study were to (1) characterize demographic and clinical factors involved in palliative transport, (2) identify challenges encountered, and and (3) ascertain staff perspectives. DESIGN Ten-year retrospective chart review and cross-sectional staff survey using study-specific questionnaire. SETTING/PARTICIPANTS Twenty-three patients had palliative transport from a tertiary pediatric hospital from 2004 to 2013, of which 12 met inclusion criteria. Survey responses from 22 participating staff were received. RESULTS The cohort of 12 patients was 58% female, with a mean (range) age of 5.5 (0.01-22) years; racial composition was not significantly different than the palliative care clinical census over the same time period. Distances under 30 miles accounted for 50% of palliative transports. The majority of patients (75%) died within 2 days of palliative transport. Six unanticipated events are described. Staff reported palliative transport as a positive experience, regarding it as an important job component. However, 63% were dissatisfied or undecided about the plan should the patient die enroute, and 48% experienced some level of dissatisfaction with communication. CONCLUSION Palliative transport is a feasible option for some patients. Staff experienced palliative transport as valuable, although process concerns were noted. This study underscores the importance of preparedness, training, and education for palliative transports.
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Affiliation(s)
- Mona Raed
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH, USA.,Indiana School of Medicine and Riley Hospital for Children at IU Health
| | - Daniel H Grossoehme
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH, USA.,Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA
| | - Miraides Brown
- Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA
| | - Sarah Friebert
- Haslinger Family Pediatric Palliative Care Center, Akron Children's Hospital, Akron, OH, USA.,Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH, USA
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13
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Menon AP, Mok YH, Loh LE, Lee JH. Pediatric Palliative Transport in Critically Ill Children: A Single Center's Experience and Parents' Perspectives. J Pediatr Intensive Care 2019; 9:99-105. [PMID: 32351763 DOI: 10.1055/s-0039-3401009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/03/2019] [Indexed: 12/29/2022] Open
Abstract
The transfer of critically ill children from intensive care units (ICUs) to their homes for palliation is seldom described. We report our 10-year pediatric palliative transport experience and conducted a survey to gain parents' perspectives of their child's transport experience. Over the study period, eight patients were transported from our pediatric ICU to their homes or hospice facilities. There were no intratransport adverse events. Parents who participated in the survey responded positively to the transport experience. The availability of a dedicated critical care transport service allowed for palliative transfers to be performed safely. Facilitating transport to allow withdrawal of life support at home is an acceptable option to families as part of holistic end-of-life care.
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Affiliation(s)
- Anuradha P Menon
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.,Children's Hospital Emergency Transport Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yee Hui Mok
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.,Children's Hospital Emergency Transport Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lik Eng Loh
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.,Children's Hospital Emergency Transport Service, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jan Hau Lee
- Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.,Children's Hospital Emergency Transport Service, KK Women's and Children's Hospital, Singapore, Singapore
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14
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Clemency BM, Grimm KT, Lauer SL, Lynch JC, Pastwik BL, Lindstrom HA, Dailey MW, Waldrop DP. Transport Home and Terminal Extubation by Emergency Medical Services: An Example of Innovation in End-of-Life Care. J Pain Symptom Manage 2019; 58:355-359. [PMID: 30904415 DOI: 10.1016/j.jpainsymman.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 10/27/2022]
Abstract
For most terminally ill patients, the preferred place of death is home. Previous literature has demonstrated the feasibility of at-home terminal extubation performed by critical care and hospice physicians. This case report describes a terminal extubation performed by a paramedic under the direct supervision of an Emergency Medical Services physician in the patient's home. Guided by a comprehensive plan and logistical support from a team of hospice providers, a successful out-of-hospital terminal extubation is possible. To truly achieve patient-centered care at end of life, the choice for an out-of-hospital death is necessary.
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Affiliation(s)
- Brian M Clemency
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Erie County Medical Center, Buffalo, New York, USA.
| | - Kathleen T Grimm
- Erie County Medical Center, Buffalo, New York, USA; Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | | | - Jenna C Lynch
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Benjamin L Pastwik
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Heather A Lindstrom
- Department of Emergency Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Michael W Dailey
- Department of Emergency Medicine, Albany Medical Center, Albany, New York, USA
| | - Deborah P Waldrop
- School of Social Work, University at Buffalo, Buffalo, New York, USA
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15
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Abstract
OBJECTIVES This article focuses on compassionate discharge from an ICU setting for pediatric patients. DATA SOURCES Not Applicable. STUDY SELECTION Not Applicable. DATA EXTRACTION Not Applicable. DATA SYNTHESIS The rationale for compassionate discharge is described, along with suggestions for assessing feasibility. A patient case highlights the potential benefits of and provides specific examples of steps involved in the process. A general framework for consideration of compassionate discharge, along with a checklist, is provided to highlight the importance of detailed planning and communication. CONCLUSIONS Although many children die in an ICU setting, some families desire end-of-life care in a nonhospital setting, often at home. For children dependent on technology, there are considerable logistical challenges to overcome, and it may not always be possible. However, with meticulous planning and close collaboration between intensive care staff, palliative care staff, and other community services, compassionate discharge can be done successfully and provide the child and family the opportunity for end-of-life care in the place most meaningful to them.
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16
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Postier A, Catrine K, Remke S. Interdisciplinary Pediatric Palliative Care Team Involvement in Compassionate Extubation at Home: From Shared Decision-Making to Bereavement. CHILDREN-BASEL 2018. [PMID: 29518983 PMCID: PMC5867496 DOI: 10.3390/children5030037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about the role of pediatric palliative care (PPC) programs in providing support for home compassionate extubation (HCE) when families choose to spend their child’s end of life at home. Two cases are presented that highlight the ways in which the involvement of PPC teams can help to make the option available, help ensure continuity of family-centered care between hospital and home, and promote the availability of psychosocial support for the child and their entire family, health care team members, and community. Though several challenges to realizing the option of HCE exist, early consultation with a PPC team in the hospital, the development of strategic community partnerships, early referral to home based care resources, and timely discussion of family preferences may help to make this option a realistic one for more families. The cases presented here demonstrate how families’ wishes with respect to how and where their child dies can be offered, even in the face of challenges. By joining together when sustaining life support may not be in the child’s best interest, PPC teams can pull together hospital and community resources to empower families to make decisions about when and where their child dies.
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Affiliation(s)
- Andrea Postier
- Pain Medicine, Palliative Care and Integrative Medicine Program, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404, USA.
| | - Kris Catrine
- Pain Medicine, Palliative Care and Integrative Medicine Program, Children's Hospitals and Clinics of Minnesota, 2525 Chicago Avenue South, Minneapolis, MN 55404, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN 55404, USA.
| | - Stacy Remke
- School of Social Work, University of Minnesota, Saint Paul, MN 55404, USA.
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17
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Translating Research to Practice: Providing Critically Ill Children the Opportunity to Go Home or to Hospice for End-of-Life Care. Dimens Crit Care Nurs 2018; 36:174-181. [PMID: 28375994 DOI: 10.1097/dcc.0000000000000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A freestanding quaternary pediatric hospital in New England has been facilitating parents' requests to take their child home or to a hospice facility from an Intensive Care Unit at end of life for the withdrawal of life sustaining measures for the past 16 years. However, knowledge of the aftermath of this decision was very limited. Before responding to a growing interest in making this service more available, an exploratory study was done to learn about the parents' perceptions of the experience over time. We learned that the parents were very positive and highly recommending that pediatric palliative transports be made more available. OBJECTIVE The aim of this study was to describe the steps and rationale used to create a structured platform for pediatric palliative transports, drawing on findings from a previous study. OUTCOMES To standardize the process, describe distinct responsibilities, and ensure quality and safety, an algorithm was created. The development of a checklist followed to enable the coordinator to follow the status of preparation for the transport. Empowered by parents' requests and positive reflections, these transports are now offered more frequently to parents of children requiring care in an intensive care unit at end of life.
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18
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Withdrawal of Life-Sustaining Therapy at Home: Broadening the View of End-of-Life Care in the PICU…Even in Children's Homes. Pediatr Crit Care Med 2017; 18:92-93. [PMID: 28060160 DOI: 10.1097/pcc.0000000000001005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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