A case-controlled study of relatives' complaints concerning patients who died in hospital: The role of treatment escalation/limitation planning

Abstract

Objectives: To independently assess quality of care among patients who died in hospital and whose next-of-kin submitted a letter of complaint and make comparisons with matched controls. To identify whether use of a treatment escalation limitation plan (TELP) during the terminal illness was a relevant background factor.

Design: The study was an investigator-blinded retrospective case-note review of 42 complaints cases and 72 controls matched for age, sex, ward location and time of death.

Setting: The acute medical and surgical wards of three District General Hospitals administered by NHS Lanarkshire, Scotland.

Participants: None.

Intervention: None.

Outcome measures: Quality of care: clinical 'problems', non-beneficial interventions (NBIs) and harms were evaluated using the Structured Judgment Review Method. Complaints were categorized using the Healthcare Complaints Analysis Tool.

Results: The event frequencies and rate ratios for clinical 'problems', NBIs and harms were consistently higher in complaint cases compared to controls. The difference was only significant for NBIs (P = 0.05). TELPs were used less frequently in complaint cases compared to controls (23.8 versus 47.2%, P = 0.013). The relationship between TELP use and the three key clinical outcomes was nonsignificant.

Conclusions: Care delivered to patients at end-of-life whose next-of-kin submitted a complaint was poorer overall than among control patients when assessed independently by blinded reviewers. Regular use of a TELP in acute clinical settings has the potential to influence complaints relating to end-of-life care, but this requires further prospective study.

Keywords: end-of-life care; patient complaints; quality of care; treatment escalation and limitation plan.