Stephen Mitchell
Resident
Atrium Health
Charlotte, North Carolina
Disclosure information not submitted.
.jpg "Stephanie Taylor, MD, (she/her/hers) photo")
Stephanie Taylor, MD, (she/her/hers)
Wake Forest School of Medicine
Charlotte, North Carolina
Disclosure information not submitted.
Shih-Hsiung Chou, PhD
Senior Data Scientist
Atrium Health, United States
Disclosure information not submitted.
Brice Taylor, MD, MS
Associate Professor
Atrium Health, United States
Disclosure information not submitted.
Title: Goal- and Family-Centered Care among Patients Undergoing Inter-ICU Transfer
Introduction: Nearly 50,000 intensive care unit (ICU) patients undergo inter-hospital transfer and transferred patients have a higher risk of death compared to non-transferred patients. However, little is known about goal- and family-centered care among these high-risk patients.
Methods: We conducted a retrospective review of 158 patients received in transfer to our tertiary care center between 2014 and 2017. We abstracted data from a full medical record review including family presence, family meetings and palliative care consultation, and transition to comfort focused care after transfer. We used descriptive statistics to report frequencies of care elements and chi-square tests to assess for group differences.
Results: Of 158 patients received in transfer, 93 (61%) had a visitor during their ICU stay. The median days to a visitor was 1 (IQR 1-2) among those who had a visitor. Only 69 (45%) of patients’ care included a family meeting; when family meetings did occur, they occurred after a median 2 (IQR 1-5) days. 4 (3%) patients’ charts included specific discussion of family experiencing barriers to visitation or participating in family meetings due to distance of the receiving hospital. 19 (12%) had palliative care consultation and 23 (15%) patients transitioned to comfort-focused care after transfer, with median 4 days (IQR: 2-11) to comfort-focused orders among those who transitioned. The frequency of transition to comfort-focused care after transfer varied across primary diagnosis category (overall p=0.02), with 60% of patients transferred for sepsis ultimately transitioning to comfort-focused care while in the ICU.
Conclusions: Patients undergoing inter-ICU transfer are at high risk for death. Maintaining a focus on patient- and family-centered care for patients received in transfer requires dedicated effort and innovative approaches. Sepsis patients appear to have a high rate of transitioning to comfort-focused care after transfer, which should be incorporated into decision making about benefits and risk of transfer in this group.