Has there been any progress in improving the quality of hospitalised death? Replication of a US chart audit study

OBJECTIVE: To describe the experience of dying in a US tertiary academic medical centre and to compare this experience with a historical decedent sample. DESIGN: A retrospective, observational, chart audit study of adults (N=159) who died in hospital. SETTING: Component hospitals of the Dartmouth-Hitchcock Medical Center: Mary Hitchcock Memorial Hospital (MHMH), Lebanon, New Hampshire, and the affiliated Veteran's Affairs Medical Center (VAMC), White River Junction, Vermont. PARTICIPANTS: 159 hospitalised adult decedents comprising a random sample of 100 MHMH decedents and a total sample of 59 VAMC decedents. METHODS: The authors compared end-of-life (EOL) care in decedents who had a palliative care consultation (PCC) with those who did not. An exploratory analysis compared the EOL care between the 2008 decedent sample and an historical decedent sample (N=104). RESULTS: 63 of 159 inpatients received a PCC. Decedents receiving a PCC were less likely to die in an intensive care unit, had fewer invasive interventions (eg, intubation, assisted ventilation, dialysis, chemotherapy) and were more likely to have advance directives, do-not-resuscitate orders and comfort measures orders than those who did not receive a PCC. Higher rates of emotional and pastoral care were also noted. Compared with the historical sample, 2008 decedents had a higher rate of invasive interventions, but fewer invasive interventions were noted in the 2008 PCC subsample. CONCLUSIONS: Less invasive EOL care was observed in decedents who received a PCC. Ongoing monitoring of EOL care is critically important for hospital quality improvement programmes.