280: TRANSPORT OF THE CRITICAL CARE PATIENT FOR WITHDRAWAL OF CARE IN THE HOME: A SCOPING REVIEW
Bibliographic record
Abstract
Introduction: While most people state they want to die at home, evidence shows that many die in an institutional setting. Deaths in the intensive care unit contribute to family distress, moral distress of staff, and organizational strain. Transport of the critical care patient to their home for withdrawal of care and death is a possible, understudied, underutilized option. The authors performed a search and scoping review to determine the current practice and trends globally. Methods: Search terms discharge of ICU patients for home hospice were searched among the databases PubMed, CINAHL, Embase, Cochrane, Web of Science and Scopus. Results were filtered to the last ten years and in the English language, which yielded 312 articles. Article abstracts were independently reviewed by two authors for the appropriate intervention: Transport of the ICU patient to home for withdrawal of care, yielding 19 articles. The authors added 6 articles via hand-searching which yielded 25 total articles for review. Results: 25 articles were reviewed published between the years 2011-2021. Most articles were case studies or retrospective chart reviews. Qualitative studies were beneficial to explore the healthcare provider perspective as well as that of the family. Most articles came from the United States and United Kingdom, with some from Australia, New Zealand, Canada and Singapore. The practice was most commonly discussed within the pediatric population, though some centers were offering the intervention to adults. Benefits discussed included: Increased ease in end-of-life discussions when the family saw the opportunity for a “better” death, enhanced family bereavement, privacy and memory making during the dying process in the home, and decreased moral distress in staff. Barriers identified include the complex interdisciplinary teamwork necessary for implementation, the varying scope of EMS across states and countries, perceived medical complexity of the patient, and caregiver support once the patient returns home. Conclusions: Critical care transport to home for the aim of withdrawal of life support and death is a safe, feasible, compassionate option for patients and their families. If this option is pursued, it involves complex multidisciplinary planning and contingency planning to mitigate challenges and maintain safety.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.041 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.005 | 0.005 |
| Bibliometrics | 0.017 | 0.019 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.005 | 0.005 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.005 | 0.002 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".