title: "The Patient Is Dying, Please Call the Chaplain": The Activities of Chaplains in One Medical Center's Intensive Care Units.
abstract: BACKGROUND
  Patients and families commonly experience spiritual stress during an intensive care unit (ICU) admission. Although most patients report that they want spiritual support, little is known about how these issues are addressed by hospital chaplains.
  
  
  OBJECTIVE
  To describe the prevalence, timing, and nature of hospital chaplain encounters in ICUs.
  
  
  METHODS
  This was a retrospective cross-sectional study of adult ICUs at an academic medical center. Measures included days from ICU admission to initial chaplain visit, days from chaplain visit to ICU death or discharge, hospital and ICU lengths of stay, severity of illness at ICU admission and chaplain visit, and chart documentation of chaplain communication with the ICU team.
  
  
  RESULTS
  Of a total of 4169 ICU admissions over six months, 248 (5.9%) patients were seen by chaplains. Of the 246 patients who died in an ICU, 197 (80%) were seen by a chaplain. There was a median of two days from ICU admission to chaplain encounter and a median of one day from chaplain encounter to ICU discharge or death. Chaplains communicated with nurses after 141 encounters (56.9%) but with physicians after only 14 encounters (5.6%); there was no documented communication in 55 encounters (22%).
  
  
  CONCLUSIONS
  In the ICUs at this tertiary medical center, chaplain visits are uncommon and generally occur just before death among ICU patients. Communication between chaplains and physicians is rare. Chaplaincy service is primarily reserved for dying patients and their family members rather than providing proactive spiritual support. These observations highlight the need to better understand challenges and barriers to optimal chaplain involvement in ICU patient care.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: philip.choi@duke.edu.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Choi
authors.affiliation: Division of Palliative Care Medicine, Department of Medicine, Duke University Medical Center; and Trent Center for Bioethics, Humanities, and History of Medicine, Duke University & School of Medicine, Durham, North Carolina, USA.
authors.forename: Farr A
authors.initials: FA
authors.lastname: Curlin
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Cox
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data; D002604:Chaplaincy Service, Hospital / Q000379:methods* / Q000706:statistics & numerical data*; D002977:Clergy / Q000706:statistics & numerical data*; D003142:Communication; D003430:Cross-Sectional Studies; D003643:Death; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009726:Nurses / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data; D010820:Physicians / Q000706:statistics & numerical data; D012067:Religion; D012189:Retrospective Studies
keywords: Intensive care; chaplain; critical care; death; religion; spiritual care