Telemedicine as a Tool to Provide Family Conferences and Palliative Care Consultations in Critically Ill Patients at Rural Health Care Institutions

Abstract

Background:

Many critically ill patients who transfer from rural hospitals to tertiary care centers (TCCs) have poor prognoses, and family members are unable to discuss patient prognosis and goals of care with TCC providers until after transfer.

Aim:

Our TCC conducted teleconferences prior to transfer to facilitate early family discussions.

Design/Setting:

We conducted a retrospective review of these telemedicine family conferences among critically ill patients requested for transfer which occurred from December 2008 to December 2009 at our TCC. Outcomes for each patient and detailed descriptions of the conference content were obtained. We also assessed limitations and attitudes and satisfaction with this intervention among clinicians.

Results:

During the 12-month period, 12 telemedicine consultations were performed. Of these patients, 10 (83%) died in the 30 days following the request for transfer. After the telemedicine consultation, 8 (67%) patients were transferred to our TCC from their respective hospitals, while 4 (33%) patients continued care at their regional hospital and did not transfer. Of the patients who transferred to TCC, 7 (88% of those transferred) returned to their community after a stay at the TCC.

Conclusion:

This study demonstrates that palliative care consultations can be provided via telemedicine for critically ill patients and that adequate preparation and technical expertise are essential. Although this study is limited by the nature of the retrospective review, it is evident that more research is needed to further assess its applicability, utility, and acceptability.

Keywords

telemedicine palliative care communication in the ICU telemedicine and communication rural health care

Get full access to this article

View all access options for this article.

References

Reeve

Runcie

Reidy

Wallace

. Current practice in transferring critically ill patients among hospitals in the west of Scotland. BMJ. 1990;300(6717):85–87.

Waydhas

. Intrahospital transport of critically ill patients. Crit Care. 1999;3(5):R83–R89.

Heyland

Allan

Rocker

Dodek

Pichora

Gafni

. Discussing prognosis with patients and their families near the end of life: impact on satisfaction with end-of-life care. Open Med. 2009;3(2):e101–e110.

Stapleton

Engelberg

Wenrich

Goss

Curtis

. Clinician statements and family satisfaction with family conferences in the intensive care unit. Crit Care Med. 2006;34(6):1679–1685.

Azoulay

Pochard

Kentish-Barnes

. Risk of post-traumatic stress symptoms in family members of intensive care unit patients. Am J Respir Crit Care Med. 2005;171(9):987–994.

Jones

Skirrow

Griffiths

. Post-traumatic stress disorder-related symptoms in relatives of patients following intensive care. Intensive Care Med. 2004;30(3):456–460.

Anderson

Arnold

Angus

Bryce

. Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med. 2008;23(11):1871–1876.

Gries

Engelberg

Kross

. Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU. Chest. 2010;137(2):280–287.

Kross

Engelberg

Gries

Nielsen

Zatzick

Curtis

. ICU care associated with symptoms of depression and posttraumatic stress disorder among family members of patients who die in the ICU. Chest. 2011;139(4):795–801.

10.

O'Mahony

McHenry

Blank

. Preliminary report of the integration of a palliative care team into an intensive care unit. Palliat Med. 2010;24(2):154–165.

11.

Norton

Hogan

Holloway

Temkin-Greener

Buckley

Quill

. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med. 2007;35(6):1530–1535.

12.

Morrison

Penrod

Cassel

. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med. 2008;168(16):1783–1790.

13.

Penrod

Deb

Dellenbaugh

. Hospital-based palliative care consultation: effects on hospital cost. J Palliat Med. 2010;13(8):973–979.

14.

Morrison

Dietrich

Ladwig

. Palliative care consultation teams cut hospital costs for Medicaid beneficiaries. Health Aff (Millwood). 2011;30(3):454–463.

15.

McKeown

Booth

Strachan

Calder

Keeley

. Unsuitable for the intensive care unit: what happens next? J Palliat Med. 2011;14(8):899–903.

16.

Yun

Lee

Kim

. Impact of awareness of terminal illness and use of palliative care or intensive care unit on the survival of terminally ill patients with cancer: prospective cohort study. J Clin Oncol. 2011;29(18):2474–2480.

17.

Bell

Somogyi-Zalud

Masaki

. Factors associated with congruence between preferred and actual place of death. J Pain Symptom Manage. 2010;39(3):591–604.

18.

Choi

Miyashita

Hirai

. Preference of place for end-of-life cancer care and death among bereaved Japanese families who experienced home hospice care and death of a loved one. Support Care Cancer. 2010;18(11):1445–1453.