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Room for improvement found in hospital care of dying patients
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The end-of-life care of dying hospital patients in a university medical center recognized for providing intensive care for the seriously ill presented several areas in need of improvement, according to study findings.
The researchers conducting the study obtained medical records that were abstracted using 16 Assessing Care of Vulnerable Elders (ACOVE) quality indicators within the end-of-life care and pain management domains. This was intended to measure the quality of the dying experience for adult decedents (n=496) hospitalized for at least 3 days between April 2005 and April 2006 at the University of California, Los Angeles, Medical Center.
Over half (56%; mean age, 62 years) of the patients were admitted to the hospital with end-stage disease, and 28% were 75 years or older. Patients received recommended care for 70% of applicable indicators (range, 25%-100%). According to researchers, goals of care were addressed in a timely fashion for patients admitted to the ICU approximately half of the time, whereas pain assessments (94%) and treatments for pain (95%) and dyspnea (87%) were performed more frequently. Follow-up for distressing symptoms was performed less well than initial assessment, they wrote, and 29% of patients extubated in anticipation of death had documented dyspnea assessments.
“Deficits in communication, dyspnea assessment, [implantable cardioverter defibrillator] deactivation and bowel regimens for patients prescribed opioids should be targeted for quality improvement,” the researchers concluded. “The findings suggest much room for improvement in treating patients dying in the hospital.” – by Brian Ellis
Walling A. Arch Intern Med. 2010;170:1057-1063.
Judging quality of care is not the same as judging quality of documentation. Free form medical documentation often leaves many holes. However (like for pain documentation), if symptoms or plans are part of a templated checklist, they always seem to improve.
– W. Douglas Weaver, MD
Cardiology Today Editorial Board member