About Careers MedBlog Contact us
Medindia LOGIN REGISTER
Advertisement

Need for Improvement in End-of-Life Care Identified After Review of Dying Patients' Charts

by Kathy Jones on June 29, 2010 at 11:00 PM
Font : A-A+

 Need for Improvement in End-of-Life Care Identified After Review of Dying Patients' Charts

A report in the June 28 issue of Archives of Internal Medicine, one of the JAMA/Archives journals, says that even at a hospital recognized for managing seriously ill patients, a systematic assessment of clinical measures associated with end-of-life care identified opportunities to improve treatment for those dying in the hospital.

Medical care during the last year of life accounts for 10 percent to 12 percent of the U.S. health care budget and 27 percent of Medicare expenditures, according to background information in the article. "Despite this intensive resource use, studies suggest that when lifesaving treatments are unsuccessful, hospitalized patients often die with distressing symptoms," the authors write. "Studies of patients who died in the hospital find that pain, dyspnea [trouble breathing] and restlessness or agitation are prevalent before death. Furthermore, persons dying in the hospital often receive burdensome care immediately before death that may not match patient preferences."

Advertisement

Anne M. Walling, M.D., of the University of California, Los Angeles, and colleagues abstracted the medical records of 496 adults (average age 62 years) who were hospitalized for at least three days before dying at a university medical center recognized for providing intensive care to the seriously ill. The researchers assessed the patients' care based on 13 quality indicators in three domains: eliciting goals of care, pain assessment and management, and dyspnea assessment and management.

More than half of the patients were admitted to the hospital with end-stage disease, one-third required removal from mechanical ventilation before death and 15 percent died while receiving cardiopulmonary resuscitation. For 70 percent of the quality indicators studied, patients received recommended care. Goals of care were addressed in a timely fashion about half the time, pain assessments were performed 94 percent of the time, and treatments for pain (95 percent) and dyspnea (87 percent) were given as recommended.
Advertisement

However, follow-up for distressing symptoms was performed less well than initial assessments, and only 29 percent of patients who had ventilation tubes removed before death were evaluated for dyspnea. An important area identified as needing improvement was communication between clinicians and patients or families at the beginning of intensive treatments.

"Even after 48 hours in the intensive care unit or on the ventilator, more than half of patients had no medical record documentation about goals of care or an attempt to pursue the topic," the authors write. "Although medical care should be tailored to achieve patient's goals and prior work shows that patients' preferences depend on prognosis, medical care cannot be guided by informed choices absent communication about current clinical status and what course is likely to follow."

"Driven in part by recognition of intensive treatments for seriously ill patients, this rigorous quality of care assessment was undertaken by an academic medical center to better understand the quality of care provided to dying patients," the authors conclude. "Deficits in communication, dyspnea assessment, implantable cardioverter-defibrillator deactivation and bowel regimens for patients prescribed opioids should be targeted for quality improvement. The findings suggest much room for improvement in treating patients dying in the hospital."

Source: Eurekalert
Advertisement

Advertisement
News A-Z
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
What's New on Medindia
Get Involved and Stand Up for Human Rights on Human Rights Day 2022
Coronary Artery Bypass Grafting
Macronutrients Calculator for Weight Loss
View all
News Archive
Date
Category
Advertisement
News Category

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Death Facts 

Most Popular on Medindia

Nutam (400mg) (Piracetam) Iron Intake Calculator Vent Forte (Theophylline) Blood Pressure Calculator How to Reduce School Bag Weight - Simple Tips Selfie Addiction Calculator Drug - Food Interactions The Essence of Yoga Accident and Trauma Care Drug Interaction Checker
This site uses cookies to deliver our services.By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use  Ok, Got it. Close
×

Need for Improvement in End-of-Life Care Identified After Review of Dying Patients' Charts Personalised Printable Document (PDF)

Please complete this form and we'll send you a personalised information that is requested

You may use this for your own reference or forward it to your friends.

Please use the information prudently. If you are not a medical doctor please remember to consult your healthcare provider as this information is not a substitute for professional advice.

Name *

Email Address *

Country *

Areas of Interests