John A Botha

Publications (2)3.79 Total impact

• Article: End of life management of adult patients in an Australian metropolitan intensive care unit: A retrospective observational study.

  Melissa Jane Bloomer, Ravindranath Tiruvoipati, Michael Tsiripillis, John A Botha
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  ABSTRACT: Death in the intensive care unit is often predictable. End of life management is often discussed and initiated when futility of care appears evident. Respect for patients wishes, dignity in death, and family involvement in the decision-making process is optimal. This goal may often be elusive. Our purpose was to review the end of life processes and family involvement within our Unit. We conducted a chart audit of all deaths in our 10 bed Unit over a 12-month period, reviewing patient demographics, diagnosis on admission, patient acuity, expectation of death and not-for-resuscitation status. Discussions with the family, treatments withheld and withdrawn and extubation practices were documented. The presence of family or next-of-kin at the time of death, the time to death after withdrawal of therapy and family concerns were recorded. There were 70 patients with a mean age of 69 years. Death was expected in 60 patients (86%) and not-for-resuscitation was documented in 58 cases (85%). Family discussions were held in 63 cases (90%) and treatment was withdrawn in 34 deaths (49%). After withdrawal of therapies, 31 patients (44%) died within 6h. Ventilatory support was withdrawn in 24 cases (36%). Family members were present at the time of death in 46 cases (66%). Family concerns were documented about the end of life care in only 1 case (1.4%). Our data suggests that death in our Unit was often predictable and that end of life management was a consultative process.
  Australian Critical Care 11/2009; 23(1):13-9. · 0.97 Impact Factor
• Source

  Available from: David V Pilcher

  Article: Interventions to circumvent intensive care access block: a retrospective 2-year study across metropolitan Melbourne.

  Graeme J Duke, Michael D Buist, David Pilcher, Carlos D Scheinkestel, John D Santamaria, Geoff A Gutteridge, Peter J Cranswick, David Ernest, Craig French, John A Botha
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  ABSTRACT: To measure the prevalence of interventions used to circumvent intensive care access block and to estimate the attributable mortality and additional hospital bed-days associated with them. Retrospective observational study of 11 adult public hospital intensive care units (ICUs) in Melbourne, Victoria, July 2004 - June 2006. Prevalence of five interventions in response to access block; attributable fatalities and/or increased length of stay associated with each. 21 896 ICU admissions and 3039 inhospital deaths (13.9%) were screened. All hospitals reported ICU access block. There were 6787 interventions for access block (mean, 9.3/day) -- 4070 (18.6% of admissions) instances of after-hours step-down from an ICU to a low-acuity ward; 1115 (5.1%) delays in an emergency department > 8 hours; 895 (4.1%) postponed major surgeries; 487 (2.2%) interhospital transfers; and 220 (1.0%) instances of premature cessation of intensive care. Based on published risk estimates, these interventions may have resulted in 91.1 (95% CI, 34.7-147.2) attributable deaths and 4368 (95% CI, 333-10 050) additional hospital bed-days each year. Intensive care access block is frequent, and measures to circumvent it increase mortality and length of stay. Further study of the health and financial implications of access block are warranted.
  The Medical journal of Australia 04/2009; 190(7):375-8. · 2.81 Impact Factor