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Crit Care Med. 2008 Apr;36(4):1138-46. doi: 10.1097/CCM.0b013e318168f301.

Using the medical record to evaluate the quality of end-of-life care in the intensive care unit.

Author information

1
Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Washington, Seattle, WA, USA. bglavan@u.washington.edu

Abstract

RATIONALE:

We investigated whether proposed "quality markers" within the medical record are associated with family assessment of the quality of dying and death in the intensive care unit (ICU).

OBJECTIVE:

To identify chart-based markers that could be used as measures for improving the quality of end-of-life care.

DESIGN:

A multicenter study conducting standardized chart abstraction and surveying families of patients who died in the ICU or within 24 hrs of being transferred from an ICU.

SETTING:

ICUs at ten hospitals in the northwest United States.

PATIENTS:

Overall, 356 patients who died in the ICU or within 24 hrs of transfer from an ICU.

MEASUREMENTS:

The 22-item family assessed Quality of Dying and Death (QODD-22) questionnaire and a single item rating of the overall quality of dying and death (QODD-1).

ANALYSIS:

The associations of chart-based quality markers with QODD scores were tested using Mann-Whitney U tests, Kruskal-Wallis tests, or Spearman's rank-correlation coefficients as appropriate.

RESULTS:

Higher QODD-22 scores were associated with documentation of a living will (p = .03), absence of cardiopulmonary resuscitation performed in the last hour of life (p = .01), withdrawal of tube feeding (p = .04), family presence at time of death (p = .02), and discussion of the patient's wish to withdraw life support during a family conference (p < .001). Additional correlates with a higher QODD-1 score included use of standardized comfort care orders and occurrence of a family conference (p < or = .05).

CONCLUSIONS:

We identified chart-based variables associated with higher QODD scores. These QODD scores could serve as targets for measuring and improving the quality of end-of-life care in the ICU.

PMID:
18379239
PMCID:
PMC2735216
DOI:
10.1097/CCM.0b013e318168f301
[Indexed for MEDLINE]
Free PMC Article

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