295 Interhospital Transfer is Not a Predictor of In-Hospital Mortality for Patients With Nontraumatic Intracranial Hemorrhage

Abstract

infarction or cardiogenic shock for 12.7%. Documented goals of care discussion was available in 18 of 181 (10%) of transfer records. Our chart review revealed 22 (12%) instances of initial goals of care discussion taking place on admission to the hospital which resulted in the decision to transition to a comfort-based end-of-life care upon arrival. Care was transitioned to a comfort-based care within the first 24 hours for 88 (49%) of the patients.Conclusions: While transfer to a higher level of care is often necessary, the sought after care should be in line with the patient's goals. In this single center review of critically ill patients, it was striking that only 1 in 10 patients who were critically ill had a discussion about their goals of care addressed and documented prior to transfer. Although the decision to transfer a critically ill patient must often be made with in information, these results suggest an opportunity to improve on the current state. The 12% of patients transitioned to comfort-based care upon arrival to our hospital suggests an opportunity to improve patient care while also decreasing unnecessary transfer. Addressing goals of care along with aggressive medical interventions is important to providing a therapy consistent with our patients' goals and avoiding costly and invasive treatments that do not align with their goals of care.