The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center. (February 2018)

• Record Type: Journal Article
• Authors: Carey, Elise C.; Dose, Ann M.; Humeniuk, Katherine M.; Kuan, Yichen C.; Hicks, Ashley D.; Ottenberg, Abigale L.; Tilburt, Jon C.; Koenig, Barbara
• Is Part Of: American journal of hospice & palliative care. Volume 35:Number 2(2018)
• Page Start: 189
• Page End: 197
• Publication Date: 2018-02
• Subjects: death -- decedent -- family caregivers -- hospitals -- quality of health care -- terminal care; Hospice care -- Periodicals; Palliative treatment -- Periodicals; 362.175
• DOI: 10.1177/1049909116689547
• Languages: English
• ISSNs: 1049-9091

Abstract

Background: The quality of perimortem care received by patients who died at our hospitals was unknown. Objective: To describe the quality of hospital care experienced in the last week of life, as perceived by decedents' families. Design: Telephone survey that included established measures and investigator-developed content. Setting: Large, tertiary care center known for high-quality, cost-effective care. Participants: Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year. Intervention: None. Measurements: Participant perceptions of the decedent's care, including symptom management, personal care, communication, and care coordination. Results: Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents' anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents' illness (29%), and receiving contradictory or confusing information (33%). Conclusion: Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.