Has there been any progress in improving the quality of hospitalised death? Replication of a US chart audit study. Issue Volume 2:Issue (2012)Supplement 1 (1st March 2012)

• Record Type: Journal Article
• Authors: Parikh, Purak; Brokaw, Frances C; Saggar, Shagun; Graves, Luann; Balan, Stefan; Li, Zhongze; Tosteson, Tor D; Bakitas, Marie
• Is Part Of: BMJ supportive & palliative care. Volume 2:Issue (2012)Supplement 1
• Page Start: 17
• Page End: 23
• Publication Date: 2012-03-01
• Subjects: Palliative treatment -- Periodicals; Terminal care -- Periodicals; 616.029
• DOI: 10.1136/bmjspcare-2011-000089
• Languages: English
• ISSNs: 2045-435X

Abstract

Abstract : Objective: To describe the experience of dying in a US tertiary academic medical centre and to compare this experience with a historical decedent sample. Design: A retrospective, observational, chart audit study of adults (N=159) who died in hospital. Setting: Component hospitals of the Dartmouth-Hitchcock Medical Center: Mary Hitchcock Memorial Hospital (MHMH), Lebanon, New Hampshire, and the affiliated Veteran's Affairs Medical Center (VAMC), White River Junction, Vermont. Participants: 159 hospitalised adult decedents comprising a random sample of 100 MHMH decedents and a total sample of 59 VAMC decedents. Methods: The authors compared end-of-life (EOL) care in decedents who had a palliative care consultation (PCC) with those who did not. An exploratory analysis compared the EOL care between the 2008 decedent sample and an historical decedent sample (N=104). Results: 63 of 159 inpatients received a PCC. Decedents receiving a PCC were less likely to die in an intensive care unit, had fewer invasive interventions (eg, intubation, assisted ventilation, dialysis, chemotherapy) and were more likely to have advance directives, do-not-resuscitate orders and comfort measures orders than those who did not receive a PCC. Higher rates of emotional and pastoral care were also noted. Compared with the historical sample, 2008 decedents had a higher rate of invasive interventions, but fewer invasive interventions were noted in the 2008 PCC subsample. Conclusions: Less invasive EOL care was observed in decedents who received a PCC. Ongoing monitoring of EOL care is critically important for hospital quality improvement programmes.