End-of-Life Hospital Care Has Room for Improvement

Study gives high marks for pain and dyspnea care, but cites lack of follow-up and communication
By Jeff Muise
HealthDay Reporter

TUESDAY, June 29 (HealthDay News) -- In U.S. hospitals, the care of patients at end of life nearly always includes close attention to pain management and efforts to ease breathing, but there are other areas of care that need improvement, according to research published in the June 28 issue of the Archives of Internal Medicine.

Anne M. Walling, M.D., of the University of California in Los Angeles, and colleagues used Assessing Care of Vulnerable Elders (ACOVE) indicators to evaluate quality of care at end of life as reflected in medical records for 496 adults who had been hospitalized for at least three days before dying.

The researchers found that more than half of the patients came to the hospital with end-stage disease. One-third of the patients had mechanical ventilation discontinued prior to death and 15 percent died during cardiopulmonary resuscitation. Patients received recommended care for 70 percent of applicable ACOVE indicators, with pain assessments, pain treatment, and dyspnea relief attended to 94, 95, and 87 percent of the time, respectively. However, goals of care were addressed in a timely way for those admitted to a critical care unit only about half the time, and follow-up for distressing symptoms was not performed as well as initial assessment. Of patients extubated in anticipation of death, 29 percent had documented dyspnea assessments.

"Deficits in communication, dyspnea assessment, implantable cardioverter/defibrillator deactivation, and bowel regimens for patients prescribed opioids should be targeted for quality improvement. The findings suggest much room for improvement in treating patients dying in the hospital," the authors write.

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