The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center

Abstract

Background: The quality of perimortem care received by patients who died at our hospitals was unknown.

Objective: To describe the quality of hospital care experienced in the last week of life, as perceived by decedents' families.

Design: Telephone survey that included established measures and investigator-developed content.

Setting: Large, tertiary care center known for high-quality, cost-effective care.

Participants: Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year.

Intervention: None.

Measurements: Participant perceptions of the decedent's care, including symptom management, personal care, communication, and care coordination.

Results: Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents' anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents' illness (29%), and receiving contradictory or confusing information (33%).

Conclusion: Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.

Keywords: death; decedent; family caregivers; hospitals; quality of health care; terminal care.

Figure

Flowchart Detailing Inclusion and Exclusion Criteria for Participants Surveyed About the Quality of Death and Dying at Mayo Clinic (Rochester, Minnesota). * Trauma was defined as hospital death within 72 hours of a traumatic accident or act of violence.