Readmissions to hospital following a decision to eat and drink with acknowledged risk.

People with a dysphagia may eat and drink with acknowledged risks (EDAR). The FORWARD care bundle (Feeding via the Oral Route With Acknowledged Risk of Deterioration) is used at our hospital to support patients who are EDAR. This two-year retrospective study of patients supported by FORWARD aimed to determine incidence of EDAR-related readmissions and effects of discharge location and documented preferred place of care in advance care plans. Of 316 patients supported by FORWARD, 200 were discharged alive. 63% (n=126) were not readmitted within six months. Of 74 patients readmitted, 49% had an EDAR-related readmission. Significantly fewer patients wishing to remain at home had EDAR-related readmissions (7%, n=4) than those without a documented preferred place of care (23%, n=30, p<0.01), suggesting advance care plans are effective. Significantly more (23%, n=29) patients discharged to private homes had EDAR-related readmissions than those in nursing/care homes (10%, n=6, p<0.05), which could suggest residential care provides more support.

Withdrawal of life-sustaining therapy in intensive care unit patients following out-of-hospital cardiac arrest: An Australian metropolitan ICU experience.

BACKGROUND: Withdrawal of life-sustaining therapy is a common phenomenon following out-of-hospital cardiac arrest. The clinical practices surrounding withdrawal of life-sustaining therapy remain unclear and warrant further inspection due to their reported impact on post-cardiac arrest mortality. OBJECTIVES: To determine factors associated with withdrawal of life-sustaining therapy (WLST) in intensive care unit (ICU) patients following out-of-hospital cardiac arrest (OHCA). METHODS: A retrospective review of ICU patients' clinical records following OHCA was conducted from January 2010 to December 2015. Demographic features, cardiac arrest characteristics, and targeted temperature management practices were compared between patients with and without WLST. We dichotomised WLST into early (ICU length of stay <72 h) and late (ICU length of stay ≥72 h). Factors independently associated with WLST were determined by multivariable binary logistic regression. RESULTS: The study cohort included 260 post-OHCA ICU patients. The mean age was 58 years, and majority were males (178, 68%); 145 (56%) underwent WLST, with the majority undergoing early WLST (89, 61%). Status myoclonus was the strongest independent factor associated with early WLST (OR 42.53, 95% CI 4.97-363.60; p < 0.001). Glasgow Coma Scale (GCS) motor response of <4 on day three post-OHCA was the strongest factor associated with delayed WLST (OR 48.76, 95% CI 11.87-200.27; p < 0.0001). CONCLUSION: The majority of deaths in ICU patients post-OHCA occurred following early WLST. Status myoclonus and a GCS motor response of <4 on day three post-OHCA are independently associated with WLST.