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Has there been any progress in improving the quality of hospitalised death? Replication of a US chart audit study
  1. Purak Parikh1,
  2. Frances C Brokaw2,3,
  3. Shagun Saggar4,
  4. Luann Graves5,
  5. Stefan Balan6,
  6. Zhongze Li7,
  7. Tor D Tosteson7,8,9 and
  8. Marie Bakitas2,3,9
  1. 1Dartmouth Medical School, Hanover, New Hampshire, USA
  2. 2Department of Anesthesiology, Section of Palliative Medicine, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
  3. 3Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire, USA
  4. 4Department of Palliative Medicine, Alice Peck Day Hospital, Lebanon, New Hampshire, USA
  5. 5Research and Development,Veterans Affairs Administration Medical Center, White River Junction, Vermont, USA
  6. 6Department of Medicine, Section of Hematology/Oncology, Veterans Affairs Medical Center, White River Junction, Vermont, USA
  7. 7Biostatistics Shared Resource, Norris Cotton Cancer Center
  8. 8Department of Community and Family Medicine, Dartmouth Medical School Hanover, New Hampshire, USA
  9. 9The Dartmouth Institute of Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire, USA
  1. Correspondence to Marie Bakitas, Department of Anesthesiology, Section of Palliative Medicine, Dartmouth Medical School, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA marie.bakitas{at}hitchcock.org

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.

  • Received 12 July 2011.
  • Accepted 1 November 2011.

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  • Received 12 July 2011.
  • Accepted 1 November 2011.
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Footnotes

  • Funding This work was supported by the Norris Cotton Cancer Center, Lebanon, NH, through a Medical Student Assistantship (PP); a Dartmouth-Hitchcock Palliative Medicine Fellowship (SS); and by NIH/NINR RO1 NR011871-01 (MB) and a National Palliative Care Research Center Career Award (MB).

  • Competing interests None.

  • Ethics approval Dartmouth College and Veterans Affairs Institutional Review Boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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