Center to Advance Palliative Care

I too do palliative care and the ICU's keep me quite busy. The goal is to reduce LOS in the ICU. If we withdraw on a pt who does not look like they will die in the elevator, we transfer to our oncology/palliative care unit for EOL/comfort care. So we are going to lower level of care, and if the pt is not actively dying, I refer to hospice who may then "flip" them to GIP, but GIP is on our unit which is considered acute care and not taking up ICU bed. If the pt still seems pretty stable the hospice will then discuss with family, going to the hospice house, if pt meets criteria, custodial level of care at SNF, or home. While sometimes the family and nurses in the ICU prefer to stay there because they have become attached, it does not make sense to take up an ICU bed and ICU nurse, and I always write orders to transfer if stable enough. Sometimes I find, the ICU will keep them until the bed is needed, but it usually works well.