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.
- Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions
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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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