End of life Care: the home placement

End of life Care: the home placementValueBasedHealthcare_logo_kleur_RGB_HR_nomineeprize2016

The ICU of the Westfriesgasthuis in Hoorn, the Netherlands, has a solid history in operational and health systems to drive policy change at local level, partly through intensive links with patients care and health care vision. An important niche for the ICU of the Westfriesgasthuis is the so called End of Life Care. It turned out that for terminal patients as well as the family of these very patients it is quite important to have the possibility to pass away in peace at home. It turned out that in regular wards of Westfriesgasthuis terminal patients are usually transferred home to pass away peacefully. But an ICU patient whose life depends often on machines- both circulatory and ventilatory-, is different. Doctors, nurses but also patients and/or family automatically assumed that it is quite impossible to transfer home these very group of patients. This outcome as well as before mentioned request resulted in a call to action from Westfriesgasthuis.

In the past a hospitalized terminal patient, in general, was more or less completely captured by the good care of medical staff. Consequently, the patients (as well as their family) had in fact no say about where, i.e. home or in the hospital, to pass away.
Fortunately this situation is slowly changing. Linked to medical social behavior in the Netherlands, the Westfriesgasthuis realized that change was imperative. So it developed the so called End of Life Care: The Home Placement program. This very program stems from the realization that patients and their family care means in principal that patients and/or their family have a controlled role, as active as possible, in the very process of passing away, including where to die.The goal of the project therefore is to enhance on request of the patient and or their family a transfer of patients to pass way at home. I.e. if the patient is stable enough to survive the transfer.

The home placement of an ICU patient means that the patient is transported home in an ambulance accompanied by an IC nurse and/or a physician assistant. At home the treatment (e.g. mechanically ventilation and/or circulatorysupport) is stopped by the nurse and /or physician assistant, and the care of the patient is taken over by the GP and family. For this, a protocol has been developed “Home placement ICU patient to die at home” and as well as a Flowchart: “home placement”. It should be stressed, that the goal of the project is certainly not to transfer home all ICU terminal patients. It will be done only if patients and/or their family wish to do so. Another condition for the home placement is the very condition of the patient: to reiterate the patient must be stable in such a way that there is a reasonable chance forarriving home alive.

It is expected by the ICU of Westfriesgasthuis to transfer home about 15 patients per year. Not only the condition of the patient is an important criterion in the decision making for home placement, but also operational levels, such as ICU staffing; availability
of ambulances co-operation of home care as well as family GPs. In addition logistic levels such as presence of certain materials, among others drug pumps, high/low beds and nursing materials. Last but not least condition as well as behavior of the patient’s
family is important, in other words is the family emotionally capable to let the patientpass away at home.