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Title: End-of-life care and intensive care unit clinician involvement in a private acute care hospital: A retrospective descriptive medical record audit.
Epworth Authors: Botti, Mari
McKenzie, Dean
Barrett, Jonathan
King, Anthony
Other Authors: Bloomer, Melissa
Keywords: ICU
Intensive Care
End of Life Care
Palliative Care
Australian National Standard
Clinician Involvement
Demographic Factors
Clinical Factors
Quality of Care
Length of Stay
Critical Care
Decision Making
Hospital Rapid Response Team
Critical Care Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Dec-2020
Publisher: Elsevier
Citation: Aust Crit Care . 2020 Dec 22;S1036-7314(20)30335-0
Abstract: Introduction: More Australians die in the hospital than in any other setting. This study aimed to (i) evaluate the quality of end-of-life (EOL) care in the hospital against an Australian National Standard, (ii) describe the characteristics of intensive care unit (ICU) clinician involvement in EOL care, and (iii) explore the demographic and clinical factors associated with quality of EOL care. Method: A retrospective descriptive medical record audit was conducted on 297 adult inpatients who died in 2017 in a private acute care hospital in Melbourne, Australia. Data collected related to 20 'Processes of Care', considered to contribute to the quality of EOL care. The decedent sample was separated into three cohorts as per ICU clinician involvement. Results: The median age of the sample was 81 (25th-75th percentile = 72-88) years. The median tally for EOL care quality was 16 (25th-75th percentile = 13-17) of 20 care processes. ICU clinicians were involved in 65.7% (n = 195) of cases; however, contact with the ICU outreach team or an ICU admission during the final inpatient stay was negatively associated with quality of EOL care (coefficient = -1.51 and -2.07, respectively). Longer length of stay was positively associated with EOL care (coefficient = .05). Specialist palliative care was involved in 53% of cases, but this was less likely for those admitted to the ICU (p < .001). Evidence of social support, bereavement follow-up, and religious support were low across all cohorts. Conclusion: Statistically significant differences in the quality of EOL care and a negative association between ICU involvement and EOL care quality suggest opportunities for ICU outreach clinicians to facilitate discussion of care goals and the appropriateness of ICU admission. Advocating for inclusion of specialist palliative care and nonclinical support personnel in EOL care has merit. Future research is necessary to investigate the relationship between ICU intervention and EOL care quality. Keywords: Critical care; Death; Decision-making; End-of-life care; Hospital rapid response team; Intensive care units; Palliative care; Quality of care.
DOI: 10.1016/j.aucc.2020.10.010
PubMed URL:
ISSN: 1036-7314
Journal Title: Australian Critical Care
Type: Journal Article
Affiliated Organisations: Deakin University, Geelong, VIC, Australia
Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia
Type of Clinical Study or Trial: Retrospective studies
Appears in Collections:Critical Care

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