Is Intensive Care becoming an out-of-hours acute palliative care se...

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DONATING INTENSIVISTS’
R.E.M. SLEEP
alex psirides
@psirides
26th march
2019
TO PALLIATIVE CARE COLLEAGUES

“
First I will define what I conceive medicine
to be. In general terms, it is to do away with
the sufferings of the sick, ...

“Most clinicians felt strongly
that end-of-life care should be
part of their core business,
but it appears that this is no...

50% of Australians will die in hospital despite
most wanting to die at home
Risk factors associated with in-hospital death...

Works with
awesome
team
James
Bond
Iron
Man
Crime
Scene
Investigator
Cool
gadgets
Deals with
death
regularly
Mostly
Works
...

Being healthy means
dying as slowly as possible

6
I think it’s clinicians’ fear.
As my oncologist said,
‘We’re here to keep you
alive.’ When I asked him
some years ago, ‘...

sick person with a
reversible process who
would benefit most
from intensive care
dying person with an
irreversible process...

the rise of the SOD
& the fall of the MOD

Barnett, Lancet 2012
Patients and
doctors are
moving in
opposite
directions

Old Medical Model Current Medical Practice
Single acute pathology Multiple chronic pathologies
Short term conditions
predo...

You can’t die without
mee0ng the MET

6
SUPPORT
THEM, THEIR
FAMILY &
YOUR
COLLEAGUES
WHILE THEY
DIE
YES
Are you
sure?
NO
DO
MEDICAL
STUFF
YES
NO
YES
TELL THEM
t...

DO
MEDICAL
STUFF
•DIAGNOSE
•TREAT
•CURE
MAKE A
DECISION

dying doesn’t have a biomarker

CRITICAL CARE CONVEYOR BELT

4
the bad death
•Occurs on bedroom floor or
in an acute hospital bed
•Nurses or doctors present,
not family or friends
•Oc...

“
To answer your question very directly, you asked
‘Do people die well in this hospital?’

They absolutely do not. People ...

3
how can we change things?
•encourage palliative care exposure for ICU trainees
•talk to patients about not doing stuff &...

“Sometimes patients know they are
dying and just hope that
someone actually mentions it at
some point.
Chaplain,
Australia...

@psirides
AlliconsfromTheNounProject
Thank you
wellingtonicu.com

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