Impact of a comprehensive supportive care team on management of hopelessly ill patients with multiple organ failure.

We developed a supportive care team for hopelessly ill patients in an urban emergency/trauma hospital. The team includes a clinical nurse specialist and a faculty physician as well as a chaplain and social worker. The supportive care team provides an alternative to intensive care or conventional ward management of hopelessly ill patients and concentrates on the physical and psychosocial comfort needs of patients and their families. We describe our experience with 20 hopelessly ill patients with multiple organ failure vs a similar group treated before the development of the supportive care team. Although there was no difference in mortality (100 percent), the length of stay in the medical ICU for patients with multiple organ failure decreased by 12 days to 6 days. Additionally, there were 50 percent fewer therapeutic interventions provided by the supportive care team vs intensive care or conventional ward treatment of multiple organ failure patients. We describe the methods that the supportive care team uses in an attempt to meet the physical and psychosocial comfort needs of hopelessly ill multiple organ failure patients and their families. This multidisciplinary approach to the care of the hopelessly ill may have applications in other institutions facing the ethical, medical, and administrative challenges raised by these patients.

Development of a comprehensive supportive care team for the hopelessly ill on a university hospital medical service.

We developed a supportive care service for a university hospital medical service that serves a socially and medically disadvantaged urban population. The team includes a faculty physician and a clinical nurse specialist who provide primary medical care, family support, and in-service guidance to hospital staff about ethical issues. A multidisciplinary approach incorporates nursing, pastoral care, social work, and other hospital services. We report our experience from November 1985 through May 1987, during which time 222 patients were referred to the team; 212 patients were accepted. The goals and operation of the service are described. The most common (n = 62, 29%) diagnosis on referral was global central nervous system anoxia following cardiopulmonary arrest. Other severe neurological conditions accounted for an additional 79 patients (37%). Comparison of patients on the service with a similar group revealed no difference in survival rate, although hospital length of stay and charges were progressively reduced after implementation of the service. This approach to the care of hopelessly ill patients may serve as an alternative method of treatment in similar hospital settings.

KIE: The authors document the first 19 months of a service dedicated to the care of hopelessly ill patients in a teaching hospital. A comprehensive supportive care team (CSCT) was established to ensure a humane, uniform, and consistent approach to the care of patients for whom aggressive care is no longer warranted. The goals and operation of the CSCT are described, including the components of patient evaluation and development of treatment plans. Results of a study of 212 patients accepted by the CSCT are reported. The authors conclude that the service successfully provided conservative but comprehensive care for the hopelessly ill, and that it increased awareness of ethical issues among hospital personnel, patients, and families.