Using the medical record to evaluate the quality of end-of-life care in the intensive care unit.
| Autor: | Glavan BJ; Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Washington, Seattle, WA, USA. bglavan@u.washington.edu, Engelberg RA, Downey L, Curtis JR |
|---|---|
| Jazyk: | angličtina |
| Zdroj: | Critical care medicine [Crit Care Med] 2008 Apr; Vol. 36 (4), pp. 1138-46. |
| DOI: | 10.1097/CCM.0b013e318168f301 |
| Abstrakt: | 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. |
| Databáze: | MEDLINE |
| Externí odkaz: |
|