An exploratory investigation into the roles of Critical Care Response Teams in end-of-life care
CCCF ePoster library. Hartwick M. Oct 27, 2015; 117336; P25
Dr. Michael Hartwick
Dr. Michael Hartwick
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Abstract
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P25


Topic: Other


An exploratory investigation into the roles of Critical Care Response Teams in end-of-life care



Adrienne Kwong, A. Sarti, M. Falconer, K. Day, G. Barton, M. Hartwick

Medicine; Division of Palliative Care, University of Ottawa, Ottawa, Canada | Medicine; Division of Critical Care, University of Ottawa, Ottawa, Canada | School of Linguistics; Communications, Carleton University, Ottawa, Canada | Innovation in Medical Education (DIME), University of Ottawa, Ottawa, Canada | Practice, Performance and Innovation Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada | Medicine; Divisions of Critical Care and Palliative Care, University of Ottawa, Ottawa, Canada

Introduction:

Recent studies have documented the participation of Critical Care Response Teams (CCRT) in end-of-life care and discussions about limitations of medical therapy.1,2,3,4,5,6 However, there is little information about the nature of these interactions or the perspectives of the individuals involved in these situations.7,8



Objectives:

To explore and describe from the perspectives of CCRT members, the roles and interactions of CCRTs in the provision of end-of-life care.



Methods:

A conceptual model, centered on the CCRT and its interrelationships with patients/families and healthcare professionals, provided the framework for a qualitative study to describe the interface between CCRT and end-of-life care. Members of the CCRT sampled in this study included registered nurses (RNs), respiratory therapists (RTs), and physicians. Data was collected through semi-structured focus groups and one-on-one interviews. Thematic coding using a modified Grounded Theory approach9 was applied to this data set and themes were agreed upon by a core coding team of 4 members comprised of two qualitative researchers, a physician, and a RN with CCRT experience. This process was iterative and continued until saturation of themes was reached.



Results:

Focus groups (n=5; 6.5 hours of data) and interviews (n=6; 4 hours of data) were conducted with RNs (n=13), RTs (n=4), and physicians (n=6) who were all established members of CCRTs at two tertiary care hospitals in Ontario, Canada. Analysis of the data revealed three major themes. Firstly, in providing end-of-life care, CCRTs integrate experience from all team members and use this collective wisdom to act as a consultative resource to other members of a patient’s circle of care. Secondly, CCRTs provide a unique skill set of multidisciplinary expertise in treating critically ill patients and evaluating the utility of intensive care treatments for patients who may be at end-of-life. Lastly, this expertise is essential in aiding patients, families, and other health care workers in decision making and in the treatment of patients who require end-of-life care. Areas that were identified as strengths of CCRTs in facilitating decision making included communication, specialist knowledge regarding critical illness, and prognostication. Challenges faced by CCRTs in providing end-of-life care included changes in the CCRT dynamic during night-time hours when residents represent the physician role on the team, and when the most responsible physician for a patient may not be present.



Conclusion:

The results from this study supports the integral role that multi-professional CCRTs play in collaborating with patients, families, and other health care teams to provide high quality end-of-life care in two Canadian university hospitals. Opportunities exist to enhance CCRTs abilities to support and educate patients/families and members of health care teams in areas such as effective communication regarding goals of care, limitations of life-sustaining therapies, and advance care planning.



References:
  1. Smith RL, Hayashi VN, Lee YI, et al: The medical emergency team call: A sentinel event that triggers goals of care discussion. Crit Care Med 2014;42(2):322-327
  2. Downar J, Rodin D, Barua R, et al: Rapid response teams, do not resuscitate orders, and potential opportunities to improve end-of-life care: a multicentre retrospective study. J Crit Care 2013;28(4):498-503
  3. Downar J, Bara R, Rodin D, et al: Changes in end of life care 5 year after the introduction of a rapid response team: A multicentre retrospective study. Resuscitation 2013;84:1339-1344.
  4. Jones DA, Bagshaw SM, Barrett J, et al: The role of the medical emergency team in end-of-life care: a multicenter, prospective, observational study. Crit Care Med 2012;40(1):98-103
  5. Vazquez R, Gheorghe C, Grigoriyan A, et al: Enhanced end-of-life care associated with deploying a rapid response team: a pilot study. J Hosp Med 2009;4(7):449-52
  6. Sulistio M, Franco M, Vo A, et al: Hospital rapid response team and patients with life-limiting illness: A multicentre retrospective cohort study. Palliative Medicine 2015;29(4):302-309
  7. Devita MA, Jones DA: Rapid response systems call: An indication for a palliative care assessment? Crit Care Med 2014;42(2):459-460
  8. Jones D, Moral J, Winters B, et al: The rapid response system and end-of-life care. Curr Opin Crit Care 2013;19(6):616-623
  9. Charmaz, K. Constructing grounded theory: A practical guide through qualitative analysis. London, UK: Sage publications, 2006
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