Late one evening, our team was paged to the emergency department to admit a 90-year-old man with a history of atrial fibrillation, ischemic cardiomyopathy, and metastatic prostate cancer experiencing 2 days of fevers and intermittent hypoxia. He had been discharged to a skilled nursing facility (SNF) from our hospital 6 days earlier following a 19-day admission for atrial fibrillation with rapid ventricular response and acutely decompensated heart failure. That stay had been prolonged due to suspected aspiration pneumonia, delirium, and physical deconditioning.
Harrison WN, Dick JF, Walsh T. Patient Preferences and End-of-Life CareA Teachable Moment. JAMA Intern Med. 2015;175(7):1087-1088. doi:10.1001/jamainternmed.2015.1283