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. 2025 Oct 16;27(4):100136.
doi: 10.1016/j.ccrj.2025.100136. eCollection 2025 Dec.

Documentation and evaluation of care of dying patients

Maria de Freitas  1 , Lucinda Roberts  1 , Alexandra Cockroft  1 , Graeme Duke  1
Affiliations

Documentation and evaluation of care of dying patients

Maria de Freitas et al. Crit Care Resusc. .

Abstract

Objective: Evaluate the quality of documentation and delivery of EOLC in the Intensive Care Unit (ICU) during the COVID-19 pandemic and compare with a pre-pandemic audit.

Design: Retrospective clinical audit of medical records of patients who died in ICU during the COVID-19 pandemic, January 2021 to February 2022, using the Documentation and Evaluation of Care of Dying Equation (DECODE) survey tool.

Setting: Three metropolitan adult ICUs in Victoria, Australia.

Main outcomes: DECODE audit score, patient characteristics, demographics, end of life planning, quality of death indicators, management of dying.

Results: There were 194 deaths over a 14-month period. 2 cases were excluded. Patients wishes were documented in 83 (43%) cases. A total of 175 patients (91%) were receiving active treatment 24 h before death. A total of 166 deaths (86%) were expected and occurred a mean of 4.5 (IQR 2-9) days from admission to ICU. A total of 52 (27%) had palliative or symptom control care plans. The median DECODE score was 14 (IQR 12-15) with statistical variation across the three sites (p=0.001). Compared to pre pandemic audits, the DECODE score was higher (p=0.001) despite pandemic restrictions.

Conclusion: EOLC in ICU remains challenging due to diagnostic dilemmas, prognostic uncertainty, and short time-frames. Assessment of quality of EoLC care helps assess and possibly improve provision of care. The DECODE questionnaire provides a semi-objective measure of quality of care provided to the dying patient in ICU.

Keywords: DECODE; Dying patient; End-of-life care; Intensive care; Palliative care.

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Conflict of interest statement

The authors declare no conflict of interest in the publication of this study.

Figures

Fig. 1
Fig. 1
Flow of patient selection included in the study.
Fig. 2
Fig. 2
Parent unit admissions by specialty. ∗Specialist surgery includes urology, vascular, ear, nose and throat, plastic, hepatobiliary, colorectal, breast and endocrine, obstretric, and thoracic surgical specialties.
Fig. 3
Fig. 3
Kernel density plot of DECODE scores for two hospitals audited in 2015/17 (n = 154) and again in 2021/22 (n = 166). Site 2 and Site 3, See Table 4. DECODE, Documentation and Evaluation of Care of Dying Equation.
See this image and copyright information in PMC

References

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