I was part of a team of palliative care providers that developed and later worked in the Safe Harbor Palliative Care Unit at the VA Medical Center in Birmingham Alabama. We came up with the name “Safe Harbor” because it resonated with military veterans and we imagined our patients as being “on the stormy seas of end-of-life looking for their Safe Harbor”. Safe Harbor quickly became the shorthand for providers, patients and families for all things Palliative and seemed to reduce the anxiety some people had about Palliative Care.
Safe Harbor and the Medical and Cardiac ICU are all on the 6th floor of the hospital. We often had transfers from an ICU to Safe Harbor when goals of care changed and ICU was no longer the best option. We started to call ourselves the Safe Harbor ICU; the Intensive Caring Unit! Clearly this was an inside joke and we didn’t want to hurt anyone’s feelings but we were taking care of the sickest people in the hospital and we providing high intensity care.
Now Brian Block has written an editorial in JAMA Internal Medicine “Does the Term Intensive Care Unit Promote Aggressive Treatment? Dr. Block suggests Critical Illness Unit or Serious Illness Unit as “good candidates to replace intensive care unit. “ He does admit that it would be difficult to get people to change the names of their ICU’s. He also notes that some hospitals with palliative care units had included “supportive” in their name and that a hospital in Boston used “intensive palliative care unit”.
Regardless of what name we use the healthcare system goal is to provide the right treatments, for the right patients and at the right time. Sometimes that will be aggressive life-sustaining treatments such as advance treatments for heart failure. Pioneered in ICU’s and for other Intensive Care is aggressive symptom management in people who are imminently dying. I join Dr. Bock in calling for a thoughtful dialogue about what intensive care means. This is the first step in matching treatments to goals of care.