 |
|
Death in the Hospital
Sarah J. Goodlin, MD;
Gary S. Winzelberg, MD;
Joan M. Teno, MD, MS;
Marie Whedon, RN, MS;
Joanne Lynn, MD, MA, MS
Arch Intern Med. 1998;158:1570-1572.
Objective To examine symptoms and treatments among hospitalized adults in the last 2 days of life.
Methods Review of 72 consecutive medical records of patients who died at an academic medical center and 32 consecutive medical records of patients who died at an affiliated Veterans Affairs hospital. Medical records were examined for documentation of symptoms, treatment, and orders to limit the use of life-sustaining interventions.
Results The 104 patients who died had an average age of 68.9 years and 70 (68%) were men. The majority had neoplasms or acquired immunodeficiency syndrome, cardiovascular disease, and end-stage lung disease; the remainder died of other acute or chronic illnesses. In the last 2 days of life, pain was noted in 49 patients (46%). Dyspnea (n=53) and restlessness or agitation (n=50) were documented in 51% of the patients. In the last 48 hours of life 12 patients (12%) underwent an attempt at resuscitation, 26 patients (27%) were receiving ventilatory support, and 18% were restrained. Nearly half of the patients (48%) had an order or progress note specifying "comfort measures only" (CMO). Patients with CMO, compared with those without such orders, had similar levels of pain, agitation, and dyspnea. Patients with CMO were less likely to be in an intensive care unit (P=.001), receive ventilatory support (P=.001), receive antibiotics (P=.009), or be weighed (P=.001).
Conclusions Baseline information with which to begin improvement of care for dying individuals was obtained through a brief retrospective chart review. While patients with CMO receive less aggressive care, no specific process was used to provide comfort care. The evaluation and testing of processes of care for dying patients are necessary to begin the improvement of care. We provide baseline data about processes and outcomes of care in our hospitals.
From the White River Junction Veterans Affairs Medical Center, White River Junction, Vt (Dr Goodlin); Dartmouth Medical School, Hanover, NH (Drs Winzelberg, Teno, and Lynn); and Mary Hitchcock Memorial Hospital, Lebanon, NH (Ms Whedon). Dr Goodlin is now with Dartmouth Medical School; Dr Winzelberg is now with Beth Israel Hospital, Boston, Mass; Dr Teno is now with the Center for Gerontology and Health Care Research, Providence, RI; and Dr Lynn is now with George Washington University Medical Center, Washington, DC.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
Circumstances of Death in Hospitalized Patients and Nurses' Perceptions: French Multicenter Mort-a-l'Hopital Survey
Ferrand et al.
Arch Intern Med 2008;168:867-875.
ABSTRACT
| FULL TEXT
Documentation on Withdrawal of Life Support in Adult Patients in the Intensive Care Unit
Kirchhoff et al.
Am J Crit Care 2004;13:328-334.
ABSTRACT
| FULL TEXT
Patients' Ratings of Quality and Satisfaction With Care at the End of Life
Sulmasy and McIlvane
Arch Intern Med 2002;162:2098-2104.
ABSTRACT
| FULL TEXT
Dying Well in Corrections: Why Should We Care?
Byock
JOURNAL OF CORRECTIONAL HEALTH CARE 2002;9:107-117.
ABSTRACT
Dying With Respiratory Disease
Sumi et al.
Chest 2001;120:1043-1044.
FULL TEXT
|
