40 What’s in a name? The intensive and palliative care unit

Abstract

Death in the Intensive Care Unit (ICU) is common (Angus 2004) and critical care admissions in the last month of life are becoming more frequent. (Teno 2013) Traditional views on the ICU as a place to only support ‘good candidates’ with deranged physiology while awaiting resolution of underlying pathology appear to be changing. An ageing and increasingly co-morbid population, alongside medical and surgical advances, have seen ICUs admit older and sicker patients year on year. Determining which patients are likely to die or to survive can be fraught with difficulty, especially early into admissions. Prognostic models, using population-level data, are fallible and reduce poorly to the individual level. As admissions progress clinical opinion constellates on clearer views of patients’ trajectories however it is likely that most will have been experiencing severe and distressing symptoms for some time.(Puntillo 2010) Relatives are also profoundly affected and represent a major area of clinical interaction and discussion.(McAdam 2010). While it may initially appear that Intensive Care and Palliative Care clinicians have divergent aims, the amelioration of distressing symptoms and focus on quality of life are in fact shared goals. What is lacking is a truly shared space to address these aims. It is time to formally acknowledge the value of bringing the Hospice to the ICU, grasping the value overlapping skillsets can bring, and anchoring the goal of bringing quality to life and dignity to death in a new name: The Intensive and Palliative Care Unit.