DECODE the quality of dying in the intensive care unit

Objective: Existing national quality of care processes do not assess quality of care for the dying patient. We developed the Documentation and Evaluation of Care of Dying Equation (DECoDE) score, a 21-point unweighted binary questionnaire. for this purpose. Design: Retrospective clinical audit by clinical staff of medical records. Setting: Two metropolitan adult intensive care units (ICU) in Victoria. Participants: 157 randomly selected records of adults who died in ICU between 1 Jan 2015 to 30 June 2017. Main outcomes: DECoDE audit score, patient characteristics, and therapeutics delivered in the last 24hrs of life. Results: Over 30 months there were 5,194 ICU admissions and 539 (10.4%) deaths, 157 (43.9%) were randomly selected for audit. 122 (82.2%) were receiving curative treatment within the 24-hours prior to death. 130 (83%) deaths were ex-pected and occurred 1.5 (IQR: 1, 4) days after agreement to withdraw treatment. Median DECoDE score was 11 (IQR: 9, 13) out of a maximum score of 21. Factors associated with a lower DECoDE score included shorter length of stay, unexpected death, and non-oncologic diagnosis. Other patient factors including age, severity of illness (APACHEIIIJ) score 102 [IQR: 80, 128]), and organ donation (7%) were not significant. Conclusion: The DECoDE audit tool may be useful for screening of care provided to dying patients in ICU. Not all patients require a high score for high quality care but a low score may indicate poor quality of care, warranting further review.