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French Multicenter Mort-a-l’Hôpital Survey

Arch Intern Med. 2008;168(8):867-875.

Background  In developed countries at present, death mostly occurs in hospitals, but the circumstances and factors associated with the quality of organization and care surrounding death are not well described.

Methods  We designed a large multicenter cross-sectional study to analyze the setting and clinical course of each patient on the day of death. We included 2750 clinical departments of 294 hospitals. Of these, 1033 departments (37.6%) of 200 hospitals (68.0%) contributed to the Mort-a-l’Hôpital survey. Data were collected prospectively by the bedside nurse of each patient within 10 days of the occurrence of death. Main outcome measures included circumstances of death in hospitalized patients; secondary outcomes, nurses' perceptions of quality of end-of-life care.

Results  Of the 1033 participating departments, 420 recorded no deaths during the study period and 613 declared at least 1 death. In the 3793 patients who died and were included for assessment, only 925 (24.4%) had loved ones present at the time of death; 70.1% had respiratory distress during the period before death; and only 12.0% were in pain. Written protocols for end-of-life care were available in 12.2% of participating departments. Only 35.1% of nurses judged the quality of dying and death acceptable for themselves. Principal factors significantly associated with this perception were availability of a written protocol for end-of-life care, anticipation of death, informing the family, surrogate designation, adequate control of pain, presence of family or friends at the time of death, and staff meeting with the family after the death.

Conclusions  This large prospective study identifies nonoptimal circumstances of death for hospitalized patients and a number of suggestions for improvement. A combination of factors reflected in the nurses' satisfaction may improve the quality of end-of-life care.

Author Affiliations: Departments of Anesthesiology and Intensive Care (Drs Ferrand and Marty and Ms Vincent-Genod) and Medical Intensive Care (Drs Lemaire and Brun-Buisson), Henri Mondor Hospital and Paris 12 University, Department of Anesthesiology and Intensive Care, Henri Mondor Hospital and EA 3409 Paris 13 University (Dr Jabre), and Department of Internal and Geriatric Medicine, Albert Chenevier Hospital and University Paris 12 (Dr Paillaud), Assistance Publique–Hôpitaux de Paris (AP-HP), Créteil; Regional Palliative Care Center, Jean-Minjoz Hospital, Besançon (Dr Aubry); Medical-Surgical Intensive Care Unit, Croix-Rousse Hospital, Lyon (Dr Badet); Medical Intensive Care Unit, District Hospital Center, Pau (Dr Badia); Medical Intensive Care Unit, Cochin-Saint-Vincent-de-Paul Hospital and Paris-Descartes University (Dr Cariou), Department of Pneumology, Tenon Hospital and Pierre et Marie Curie University (Dr Gounant), Infection Control Unit, Bichat-Claude Bernard Hospital (Dr Regnier), and Haematology Department and Bone Marrow Transplant Unit and Laboratory of Cellular Therapy, Saint-Louis Hospital and Paris 7 University (Dr Socie), AP-HP, Paris; Palliative Care Unit, Champcueil Hospital, AP-HP, Champcueil (Ms Ellien); Department of Neurology, La Milétrie Hospital and Poitiers University, Poitiers (Dr Gil); Department of Anesthesiology and Intensive Care B, Saint Eloi Hospital and University of Montpellier I (Dr Jaber), and District Hospital Center (Dr Jay), Annonay; Coordination of External Care and Palliative Care, Gustave Roussy Institute, Villejuif (Dr Poulain); Medical-Surgical Intensive Care Unit, District Hospital Center, La Roche-sur-Yon (Dr Reignier); and Emergency Department, Bellevue Hospital, Saint-Etienne (Dr Tardy), France.

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