 A Chart Review of Seven Hundred Eighty-Two Deaths in Hospitals, Nursing Homes, and Hospice/Home Care While most people die in the hospital or a nursing home, surveys indicate that
more than 70% of people would prefer to die at home. Expert panel recommendations
have called for epidemiologic studies to document the nature of dying in America.
These researched wanted to determine if the experience of dying differed among
settings in the state of New Hampshire. A voluntary, statewide medical record
audit of adult deaths in hospitals, nursing homes, and home care/hospice agencies
was conducted for February and March 2002. Records were examined for place of
death, patient decision-making capacity, and advance directives (ADs). Demographics
were collected as well as primary and secondary diagnoses, presence of documented
discussions with patients about their values and end-of-life care, and whether
emotional and spiritual support was provided to patients and their families.
Medical chart notes for the 48 hours preceding death were reviewed for "pain"
and "other symptoms routinely assessed, treated and documented," and
for whether the patient had undergone treatments such as surgery, ventilator,
cardiopulmonary resuscitation, or extubation. The researchers reported that
nearly one third (32%) of healthcare organizations in the state reported on
782 deaths (424 hospital, 148 nursing home, and 210 home care/hospice) representing
44% of the adult deaths during this period. Significant differences among settings
were found for mean age, gender, marital status, primary insurance, diagnosis,
ADs, symptom assessment, and provision of emotional and spiritual support for
patients and families. Among those who died in hospitals, 56% were in acute
care beds, 30% were in intensive care units, and 4% were in palliative care
beds. Nineteen percent of these patients received interventions such as extubation,
ventilator, or surgery in the 48 hours preceding death. Over 80% had a do-not-resuscitate
(DNR) order, 45% had a Durable Power of Attorney for Health Care, and 37% had
a Living Will. Age and setting were significant factors in the presence of ADs.
The investigators concluded that this information provides a benchmark for different
care systems to identify areas for improvements in end-of-life care. Solloway
M, Lafrance S, Bakitas M, Gerken M. Adapted from J Palliat Med. 2005 Aug;8(4):789-96. |
| Department of Pain Medicine and Palliative Care Beth Israel Medical Center, New York City ©2005 Continuum Health Partners, Inc. www.stoppain.org/palliative_care |
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