Has there been any progress in improving the quality of hospitalised death? Replication of a US chart audit study.
Has there been any progress in improving the quality of hospitalised death? Replication of a US chart audit study.
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在改善住院死亡质量方面有何进展？
DOI：
10.1136/bmjspcare-2011-000089
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发表时间：
2012
影响因子：
2.7
通讯作者：
Bakitas,Marie
中科院分区：
文献类型：
--
作者：
Parikh,Purak;Brokaw,FrancesC;Saggar,Shagun;Graves,Luann;Balan,Stefan;Li,Zhongze;Tosteson,TorD;Bakitas,Marie
目的描述在美国第三学术医疗中心死亡的经验，并将此经验与历史死者样本进行比较。设计一项回顾性、观察性、图表审计研究，研究对象为在医院死亡的成年人（N=159）。设置达特茅斯-希区柯克医疗中心的组成医院：玛丽希区柯克纪念医院（MHMH），黎巴嫩，新罕布什尔州，和附属退伍军人事务医疗中心（VAMC），白河交汇处，Vermont. Vermarts 159住院的成年死者，包括随机抽样的100 MHMH死者和59 VAMC的总样本decedents.MethodsThe作者比较了临终关怀（EOL）的死者谁有姑息治疗咨询（PCC）与那些没有。探索性分析比较2008年死亡样本和历史死亡样本（N=104）之间的EOL护理。与未接受PCC的患者相比，接受PCC的患者在重症监护室死亡的可能性较小，侵入性干预（例如插管、辅助通气、透析、化疗）较少，并且更可能有预先指示、不复苏命令和舒适措施命令。还注意到情感和精神关怀的比例较高。与历史样本相比，2008年死者有较高的侵入性干预率，但较少的侵入性干预措施，注意到在2008年PCC subsample.ConclusionsLess侵入性EOL护理中观察到死者谁收到PCC。对临终关怀的持续监测对于医院质量改进计划至关重要。
ObjectiveTo describe the experience of dying in a US tertiary academic medical centre and to compare this experience with a historical decedent sample.DesignA retrospective, observational, chart audit study of adults (N=159) who died in hospital.SettingComponent 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.Participants159 hospitalised adult decedents comprising a random sample of 100 MHMH decedents and a total sample of 59 VAMC decedents.MethodsThe 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).Results63 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.ConclusionsLess invasive EOL care was observed in decedents who received a PCC. Ongoing monitoring of EOL care is critically important for hospital quality improvement programmes.