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Randomized Controlled Trial
. 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

Bradford J Glavan  1 , Ruth A Engelberg, Lois Downey, J Randall Curtis
Affiliations
Randomized Controlled Trial

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

Bradford J Glavan et al. Crit Care Med. 2008 Apr.

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.

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Figures

Figure 1
Figure 1
Exclusion criteria and identification of 356 cases for analysis.
See this image and copyright information in PMC

Comment in

References

    1. Angus DC, Barnato AE, Linde-Zwirble WT, Weissfeld LA, Watson RS, Rickert T, Rubenfeld GD. Use of intensive care at the end of life in the United States: An epidemiologic study. Crit Care Med. 2004;32:638–643. - PubMed
    1. Prendergast TJ, Claessens MT, Luce JM. A national survey of end-of-life care for critically ill patients. Am J Respir Crit Care Med. 1998;158:1163–1167. - PubMed
    1. Jayes RL, Zimmerman JE, Wagner DP, Knaus WA. Variations in the use of do-not-resuscitate orders in ICUs: findings from a national study. Chest. 1996;110:1332–1339. - PubMed
    1. Ferrand E, Robert R, Ingrand P, Lemaire F. Withholding and withdrawal of life support in intensive-care units in France: a prospective survey. Lancet. 2001;357:9–14. - PubMed
    1. Keenan SP, Busche KD, Chen LM, Esmail R, Inman KJ, Sibbald WJ. Withdrawal and withholding of life support in the intensive care unit: a comparison of teaching and community hospitals. Crit Care Med. 1998;26:245–251. - PubMed

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