Barriers to High Quality End of Life Care in the Surgical Intensive Care Unit

Ricardo Diaz Milian

Research output: Contribution to journalArticlepeer-review

Abstract

End of life discussions frequently take place in surgical intensive care units, as a significant number of patients die while admitted to the hospital, and surgery is common during the last month of life. Multiple barriers exist to the initiation of these conversations, including: miscommunication between clinicians and surrogates, a paternalistic approach to surgical patients, and perhaps, conflicts of interest as an unwanted consequence of surgical quality reporting. Goal discordant care refers to the care that is provided to a patient that is incapacitated and that is not concordant to his/her wishes. This is a largely unrecognized medical error with devastating consequences, including inappropriate prolongation of life and non-beneficial therapy utilization. Importantly, hospice and palliative care needs to be recognized as quality care in order to deter the incentives that might persuade clinicians from offering these services.

Original languageEnglish (US)
JournalAmerican Journal of Hospice and Palliative Medicine
DOIs
StateAccepted/In press - 2020

Keywords

  • end of life
  • goal discordant care
  • inappropriate prolongation of life
  • quality reporting
  • surgical intensive care
  • surgical mortality reporting

ASJC Scopus subject areas

  • Medicine(all)

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