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In-hospital do-not-resuscitate (DNR) orders in the State of Texas have faced much tighter regulation since April 2018. With Senate Bill 11, both the meaning of a DNR order and the circumstances in which it can be entered are now more tightly defined.
Kyle B. Enfield, MD, and Marin H. Kollef, MD, discuss the findings and design of the cluster randomized crossover trial on early palliative care consultation in the medical intensive care unit (ICU) published in the December 2019 issue of Critical Care Medicine (Ma J, et al. Crit Care Med. 2019;47;1707-1715).
Dr. Kollef outlines the automatic triggers for palliative care consultations that were chosen for the study, the reactions of the transplant physicians and the nursing staff to the study, and the importance of communication in palliative care between the ICU staff, palliative care experts, patients, and families.
Dr. Kollef is a professor of medicine at Washington University of Medicine in St. Louis Missouri, USA. This podcast is sponsored by Sound Critical Care.
Ludwig H. Lin, MD, speaks with Dan R. Thompson, MD, MA, MCCM, Professor of Surgery, Anesthesiology, and Bioethics at Albany Medical College in Albany, New York. Dr. Thompson discusses end-of-life decision-making and “Substituted Judgment: Who Speaks for This Patient?” which he presented at the 44th Critical Care Congress in Phoenix, Arizona.
Michael Weinstein, MD, FACS, FCCP, speaks with J. Randall Curtis, MD, MPH, to discuss the article, “Hospital Variation and Temporal Trends in Palliative and End-of-Life Care in the ICU,” which was published in the July issue of Critical Care Medicine. Dr. Curtis and his co-investigators found that there is significant variability in how palliative and end-of-life care is delivered hospital to hospital. Dr. Curtis is a professor in the Division of Pulmonary and Critical Care Medicine at Harborview Medical Center and the University of Washington in Seattle, Washington.
Michael Weinstein, MD, FACS, FCCP, speaks with Joanne L. Hart, MD, about her article published in the September Critical Care Medicine, “Perceptions of Organ Donation After Circulatory Determination of Death Among Critical Care Physicians and Nurses: A National Survey.” This article aimed to determine if this type of organ donation was accepted by critical care providers as well as its impact on end-of-life care. Hart is a pulmonary and critical care fellow at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia, Pennsylvania.
John M. Luce, MD, FCCM, discusses his latest article, “A History of Resolving Conflicts Over End-of-Life Care in Intensive Care Units in the United States,” published in the August 2010 issue of Critical Care Medicine. The article discusses the impact of end-of-life decisions on physicians, the team and the family, particularly when conflicts in opinion arise. Luce is a professor emeritus at the University of California, San Francisco, as well as a physician at San Francisco General Hospital.
Constantine A. Manthous, MD, associate clinical professor of medicine at Bridgeport Hospital and Yale University School of Medicine in Connecticut, discusses his article published in the April 2009 issue of Critical Care Medicine, “Why Not Physician-Assisted Death?” The article sparked several letters to the editor, an editorial, and a response from Manthous, titled "Flawed Assumptions Surround Concept of Physician-Assisted Death."
Martha A.Q. Curley, RN, PhD, associate professor of nursing, anesthesia and critical care medicine at the University of Pennsylvania and nurse scientist at Children's Hospital in Boston, discusses an article published in the May 2007 issue of Pediatric Critical Care Medicine, "Pediatric Staff Perspectives on Organ Donation after Cardiac Death in Children."
Peter C. Laussen, MD, discusses an article published in the May 2007 issue of Pediatric Critical Care Medicine, titled "Pediatric Staff Perspectives on Organ Donation After Cardiac Death in Children." Dr. Laussen is director of the cardiac intensive care unit at Children's Hospital Boston. This is the first podcast in a two-part interview. Part two will feature an interview with lead author Martha A.Q. Curley, RN, PhD.
Douglas White, MD, discusses his article in the August issue of Critical Care Medicine, "Decisions to Limit Life-Sustaining Treatment for Critically Ill Patients Who Lack Both Decision-Making Capacity and Surrogate Decision Makers." Dr. White is an assistant professor of medicine at the University of California San Francisco Medical Center.
Michael S. Weinstein, MD, FACS, FCCM, speaks with Gerard J. Fulda, MD, about the guideline, “Management of the Potential Organ Donor in the ICU: Society of Critical Care Medicine/American College of Chest Physicians/Association of Organ Procurement Organizations Consensus Statement,” published in Critical Care Medicine. With this article, Dr. Fulda and coauthors aim to provide critical care practitioners with essential information and practical recommendations related to management of the potential organ donor, based on the available literature and expert consensus.
Michael Weinstein, MD, FACS, FCCP, speaks with Judith Nelson, MD, JD, lead author on an article published in the October Critical Care Medicine, “Choosing and Using Screening Criteria for Palliative Care Consultation in the Intensive Care Unit: A Report From The IPAL-ICU (Improving Palliative Care in the ICU) Advisory Board.” The authors found that use of specific criteria to prompt proactive referral for palliative care consultation seems to help reduce utilization of ICU resources without changing mortality, while increasing involvement of palliative care specialists for critically ill patients and families in need. Dr. Nelson is professor of medicine in the Division of Pulmonary, Critical Care and Sleep Medicine and the Hertzberg Palliative Care Institute at Mount Sinai School of Medicine in New York, New York. She is also the director of the IPAL-ICU (Improving Palliative Care in the ICU) Project.
Michael Weinstein, MD, FACS, FCCP, speaks with Alyssa Majesko, MD, MS, about her article published in the August Critical Connections, which discusses the importance of training fellows in palliative care and the use of effective communication. Majesko is an assistant professor in the Division of Internal Medicine with appointments in the Center for Palliative Care and the Center for Critical Care at Emory University in Atlanta, Georgia.
Elaine Meyer, RN, PhD, discusses a paper published recently in Pediatric Critical Care Medicine, titled “Difficult Conversations: Improving Communication Skills and Relational Abilities in Healthcare.” Meyer, a clinical psychologist, is the Director of the Institute for Professionalism and Ethical Practice at Children’s Hospital Boston, Massachusetts. She also is Associate Professor of Psychology at Harvard Medical School.
Robert D. Truog, MD, MA, discusses new guidelines published in the March 2008 issue of Critical Care Medicine, "Recommendations for End-of-Life Care in the ICU." Dr. Truog is professor of medical ethics and anesthesia (pediatrics) at Harvard Medical School and senior associate in critical care medicine at Children's Hospital Boston in Massachusetts.
Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were answered. This microlearning content was taken from the COVID-19 Critical Care for Non-ICU Clinicians: Expert Panel Series held on May 27th, 2020.
This resource details how compassion in healthcare has changed with COVID-19. This is a community developed COVID-19 microlearning resource.
In this question and answer webcast series, attendees had an opportunity to pose questions about managing critically ill patients with COVID-19 and other issues. Questions from social media, blogs and the various discussion forums, including the new SCCM COVID-19 Discussion Group, were also answered. Recorded on: Friday, May 22, 2020
From Critical Care Medicine. The authors write in response to an article in Critical Care Medicine by Sprung et al., which outlined the major considerations for ethical ICU triaging under pandemic conditions and discuss the lack of systematic triaging in U.S. health care institutions.
From Critical Care Explorations. In this review articles, the authors set out to identify the most ethical way a given healthcare system may respond to a patient’s refusal to undergo coronavirus disease 2019 testing.