280: TRANSPORT OF THE CRITICAL CARE PATIENT FOR WITHDRAWAL OF CARE IN THE HOME: A SCOPING REVIEW

Abstract

Introduction: While most people state they want to die at home, evidence shows that many die in an institutional setting. Deaths in the intensive care unit contribute to family distress, moral distress of staff, and organizational strain. Transport of the critical care patient to their home for withdrawal of care and death is a possible, understudied, underutilized option. The authors performed a search and scoping review to determine the current practice and trends globally. Methods: Search terms discharge of ICU patients for home hospice were searched among the databases PubMed, CINAHL, Embase, Cochrane, Web of Science and Scopus. Results were filtered to the last ten years and in the English language, which yielded 312 articles. Article abstracts were independently reviewed by two authors for the appropriate intervention: Transport of the ICU patient to home for withdrawal of care, yielding 19 articles. The authors added 6 articles via hand-searching which yielded 25 total articles for review. Results: 25 articles were reviewed published between the years 2011-2021. Most articles were case studies or retrospective chart reviews. Qualitative studies were beneficial to explore the healthcare provider perspective as well as that of the family. Most articles came from the United States and United Kingdom, with some from Australia, New Zealand, Canada and Singapore. The practice was most commonly discussed within the pediatric population, though some centers were offering the intervention to adults. Benefits discussed included: Increased ease in end-of-life discussions when the family saw the opportunity for a “better” death, enhanced family bereavement, privacy and memory making during the dying process in the home, and decreased moral distress in staff. Barriers identified include the complex interdisciplinary teamwork necessary for implementation, the varying scope of EMS across states and countries, perceived medical complexity of the patient, and caregiver support once the patient returns home. Conclusions: Critical care transport to home for the aim of withdrawal of life support and death is a safe, feasible, compassionate option for patients and their families. If this option is pursued, it involves complex multidisciplinary planning and contingency planning to mitigate challenges and maintain safety.