Terminally ill patients in intensive care units and their families; patients with eight categories of non-cancer terminal illnesses.

Keelung Chang Gung Memorial Hospital serves as a regional referral center for critical care in Northeast Taiwan and has long undertaken the care of a large number of critically ill patients. With advances in medical technology, an increasing number of terminal and non-cancer terminal patients receive treatment in intensive care units. Without timely integration of palliative care, this may lead to overtreatment and increased physical and psychological burden for patients and families.

To address this issue, the hospital introduced palliative care into critical care settings in 2013 and established the “CARING” model, emphasizing early identification, interdisciplinary collaboration, symptom management, patient autonomy, and dignity at the end of life. Through the integration of physicians, nurses, palliative care specialists, social workers, psychologists, and spiritual care resources, the program provides holistic end-of-life care, accompanying patients and families through the final journey of life and embodying the belief that “medicine is not only about treatment, but also about companionship.”

Centered on the “CARING” framework, this program integrates intensive care and palliative care, establishing an interdisciplinary collaborative model. Palliative care is initiated promptly within intensive care units, ensuring patient autonomy, effective symptom control, and dignified end-of-life care.

1.A total of 57 ICU beds across the hospital campuses

2.ICU inpatient days:

2022: 17,044

2023: 16,433

2024: 14,908

3.DNR consent cases:

2022: 339 cases

2023: 287 cases

2024: 201 cases

4.Patients with non-cancer terminal illnesses included in palliative co-care services

• Stable annual number of ICU DNR consent cases

• Continuous improvement in palliative co-care implementation rate

• Increased satisfaction with family decision-making processes

• Reduction in unnecessary invasive medical treatments

• ICU bed occupancy rate decreased:

• 2022: 81.9%

• 2023: 79.0%

• 2024: 71.7%

• ICU mortality rate in 2024: 15.0%

• 100% of medical equipment included in asset management system

• Palliative care provided in accordance with standardized clinical protocols

• Implementation of patient safety incident reporting system

• Family feedback affirming the quality of end-of-life companionship

• Sustained positive family satisfaction with care services

• High satisfaction with interdisciplinary team collaboration

• Favorable feedback on palliative care services

• Alignment with international trends in palliative care for critical illness

• Development of care models based on international literature

• Active participation in academic exchange and experience sharing domestically and internationally

• Established an integrated model combining intensive and palliative care, improving overall healthcare quality.

• Standardized clinical workflows for ICU palliative care, contributing to consistent treatment and care standards.

• Enhanced patients’ quality of life and dignity at the end of life, while reducing families’ decision-making burden.

• Reduced unnecessary invasive treatments, promoting efficient and sustainable use of medical resources.

• Strengthened interdisciplinary collaboration, supporting long-term sustainability of the healthcare system.