Background

Shared decision making regarding direction and ‘place of care’ is key concept of realistic medicine. Admission to paediatric intensive care unit (PICU) usually aims at restorative therapy. For small cohort of patients however re-orientation of care becomes most appropriate. Practice of reorientation of care has evolved and involves close collaboration with a multidisciplinary team and parents.

Objectives

Review current literature regarding re-orientation of care at home for children at end of life, with an aim to develop a guideline for implementation in our local PICU.

Methods

A literature search performed to identify UK current practice. Retrospective analysis of deaths that occurred in our PICU from 2010-2017 and identification of those who may have been applicable for re-orientation of care out-with critical care. Development of a guideline and discharge checklist to implement in clinical practice.

Results

Between 2010-2017, within our unit, there were 76 deaths, 28 (37%) were identified as appropriate for re-orientation of care out-with critical care.

The guideline involves six steps. It identifies a patient, clarifies wishes and choice of place of care, and discusses with appropriate service to take over the patient’s care. Pre-transfer involves rationalising care for transfer and completion of CYPADM/ACP. Transfer would be performed by critical care team members, prior to compassionate re-orientation of care and handover to appropriate service.

Conclusion

Choice of home as final place of care around time of death should be considered for relevant patients in critical care and this guideline and discharge checklist will aid the medical team to offer this service.