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Time to shut down the acute care conveyor belt?

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A rapid response system may be an appropriate model for meeting the urgent need for more suitable care for patients at the end of life

Hospitals can be dangerous places where people can unexpectedly die. Hospitals can also be dangerous places because people are not allowed to die. When they eventually die, it can be a prolonged and demeaning experience.1,2

The population of the world is increasing. People are living longer. An increasing number of aged people are spending their last few days, weeks or months in acute hospitals,3 many of whom will die in intensive care units (ICUs).4 Almost a third of Americans will spend time in an ICU during the last month of their life.4 However, most people want to die at home, not in an acute care hospital.

Discussions around the end of life (EOL) are ubiquitous and the term can be interpreted in many different ways. For the purposes of this article, we limit the term EOL to older people with significant comorbidities who, based on existing evidence, have less than 1 year to live. If EOL care in acute hospitals is one of the largest contributors to health care costs and if our society does not want it, how did it happen and how can we manage EOL care more appropriately and in line with…