End-of-Life Care in Scottish Intensive Care Units

Abstract

We wished to assess practice, staff attitudes and desire for change in the way dying patients are cared for in intensive care units (ICUs) in Scotland. A questionnaire was distributed to all 23 general ICUs in Scotland, for medical and nursing staff of all grades to fill in. A dying patient was defined as one in whom a decision had been taken to withdraw or withhold intensive care in the expectation that the patient would die in less than 12 hours; respondents first answered questions about current practice in their ICU, immediately followed by questions concerning ideal practice. The response rate was 62% with the majority of staff being satisfied with current practice, although even the respondents who were satisfied overall would significantly change delivery of care in some areas. A small number (<1%) would not reduce or stop ventilatory, cardiovascular or renal support. In this survey, the withdrawal and limitation of life-sustaining treatment in Scottish ICUs was common, but variable in practice. Institution of a common care pathway at the end of life would allow each unit to decide on the best process to facilitate high-quality end-of-life care, and have robust systems in place to ensure it is consistently delivered.