103 Transforming and normalising palliative care in critical care; analysis of a decade of palliative critical care in Southampton

<h3>Introduction</h3> Ten years ago our Hospital Palliative Care (HPCT) and General Intensive Care Unit (GICU) Teams began a quality improvement initiative to better address palliative care needs of GICU patients. Palliative Critical Care now involves seamless inter-disciplinary, cross-speciality working supported by one session/week of Intensivist and two of Palliative Medicine Consultant time. Here, we detail an analysis of the evolving referral pattern and patient outcomes. <h3>Methods</h3> Retrospective review of HPCT and GICU records April 2013 to March 2024 with detailed analysis of data from years 1, 5 and 10 (2014/15, 2018/19 and 2023/24). <h3>Results</h3> 1033 patients were referred. Most years, the number increased year on year; 57, 98 and 136 for the index years. Referrals dipped in 2020/21 because of the Covid pandemic. The percentage of referrals for non-cancer conditions increased; 59%, 79% and 78% respectively; the range of diagnoses were very broad. In 2023/24 the non-cancer diagnosis included 16% with out of hospital cardiac arrest, 9.5% with complications of liver cirrhosis and 11% trauma cases. Tracheostomy ventilated GICU patients (6 in 2023/24) are more likely to be discharged home. Although the proportion who died on GICU dropped over the years, the in-hospital mortality rate rose from approximately 50% in years 1 and 5 to 65% in year 10. Of those referred in 2023/24, 18% are still alive as of October 2024. Areas of impact included symptom control, psychological support, family support, care whilst dying, staff support and, increasingly, complex clinical decision making. Informal and formal teaching and regular attendance GICU morbidity and mortality meetings are vital. <h3>Conclusion</h3> This flourishing collaboration has normalised palliative care involvement on GICU. The numbers of referrals, range of diagnoses and breadth of advice sought have evolved over time. It seems likely that this initiative has increased throughput through the GICU beds.