As the current/accepting resident team, please make sure to write an Advanced Care Planning note with the dotphrase .ACEPRIMARYTEAM in order to communicate this to future teams caring for this patient and provide specific recommendations to your night team about contingency plans that have been discussed by your attending. The nature of this type of situation is that patients will likely decompensate, so your night team and night seniors should have clear guidance about what diagnostic testing and interventions will offer benefit to your patient in the handoff tab. Please be sure to spend time thinking about these questions with your attending on rounds, so that the team develops a plan that everyone understands and feels comfortable with. You can feel free to adapt the language below, as applicable.
If patient becomes more hypotensive, the team has discussed that escalation of the [insert medication] dose beyond [insert dose] or the addition of a (abx/second pressor/antiarrhythmic/AEDs) would not be beneficial to this patient and will prolong their dying process.
- Dr. Patrick Chae and Dr. Glen Chun are available to assist with daily management of both pulmonary and critical care needs (e.g. questions about vent management, sedation, pressors) for patients who would not benefit from ICU care; please discuss with your attending about involving them in the care of the patient early.
- For acute issues that require immediate critical care attention, please consult RRT.
- Please remember that patients who are deemed not to benefit from the ICU should be provided care that is beneficial for the patient – the goal is not to re-create the ICU on the floor. If questions or clarification are needed about what can or should be provided on the Step Down Unit, please discuss with your attending and unit leadership.
- Chaplaincy is available to help support the team/family and are reachable via an Epic order.
- For all patients where Palliative Care is not following (or the family isn't open to Palliative Care consultation), the Hospitalists Primary Pall Care team (HPPC) is available for team support and help communicating with patients/families.
- Finally, for ethical issues around complex end-of-life scenarios, please remember an Ethics consult remains available. The Ethics team can be reached via mshethics@mountsinai.org or AMiON under dropdown: “Ethics - MSH”.