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Health & Fitness

Dying To Get Out of ICU

I don't want my last days spent in an ICU, do you? If you don't want to die in an ICU, read on. Your Advance Directive will not necessarily prevent you from spending your last moments surrounded by technology, rather than your family. "End-of-Life Care in California: Your Don't Always Get What You Want," posted on the California Healthcare Foundation's website provides hard data about trends in local ICUs and hospice care. Here's the link:
http://www.chcf.org/publications/2013/04/eol-what-you-want

A little over two thirds of Californians prefer to die at home, prefer a natural death (or at least a low intensity of care), and believe that it's "extremely important" to be comfortable and pain-free. In order to compare this to what actually happens, Dartmouth studied the actual rates in 2003 and 2010. They compared the rates to determine trends at each facility and within certain geographical areas.

The percentage of change lets us know how our facilities are trending. We want to see the number of ICU deaths go down during the last 6 months of life, right? But in California, they increased by 3%! In Contra Costa County, however, saw a 4% decrease in their ICU deaths during the last 6 months of life. Good job, Contra Costa! But in Napa they increased by a whopping 21%! Uh oh, wrong direction, big time! The difference is even more dramatic between hospitals. There were 12% fewer patients in Alta Bates' ICU during their last 6 months. Hmmm, they must be doing something right. But Queen of the Valley saw an increase of 33%! My advice: stay away from Queen of the Valley when your end is near, unless you want it to be in ICU!

Now, to look at dying pain-free, in comfort and with little to no technology, let's take a look at the number of hospice days during the last 6 months. We want to see more days in hospice, since most aren't enrolled until they are within 3 days of death. This means they suffered a lot more than they should have. California did really well with a 21% increase in hospice days. San Francisco did even better with an increase of 30%! But, once again, Napa only saw a rise of 3%. Not much change going on there. Northbay Hospital is doing great with a 77% increase in their number of hospice days. But their Vaca Valley division actually decreased their hospice days by 21%! What's going on over there? Finally, I have to add Sutter Solano, who has done a great job by increasing their hospice days 39%.

When hospitals put more people into ICU at the end of their life, we have to wonder why. Is it profits? Are the physicians unaware of their patients' preferences or progressive trends in health care? Are they influenced by the stigma around end-of-life? 

Similarly, we have to question why some remain reluctant to offer their patients hospice care. Are they assuming that it's not what their patients want? Does it represent "giving up" on the patient? Do they mistakenly believe that hospice is a withdrawal of care? These ideas must change. Here is a website on how to have "the conversation" with our providers and families. 
 http://theconversationproject.org/

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