Using the medical record to evaluate the quality of end-of-life care in the intensive care unit.
BACKGROUND
We investigated whether proposed "quality markers" within the medical record are associated with family assessment of the quality of dying and death in the intensive care unit (ICU).


OBJECTIVE
To identify chart-based markers that could be used as measures for improving the quality of end-of-life care.


METHODS
A multicenter study conducting standardized chart abstraction and surveying families of patients who died in the ICU or within 24 hrs of being transferred from an ICU.


METHODS
ICUs at ten hospitals in the northwest United States.


METHODS
Overall, 356 patients who died in the ICU or within 24 hrs of transfer from an ICU.


METHODS
The 22-item family assessed Quality of Dying and Death (QODD-22) questionnaire and a single item rating of the overall quality of dying and death (QODD-1).


METHODS
The associations of chart-based quality markers with QODD scores were tested using Mann-Whitney U tests, Kruskal-Wallis tests, or Spearman's rank-correlation coefficients as appropriate.


RESULTS
Higher QODD-22 scores were associated with documentation of a living will (p = .03), absence of cardiopulmonary resuscitation performed in the last hour of life (p = .01), withdrawal of tube feeding (p = .04), family presence at time of death (p = .02), and discussion of the patient's wish to withdraw life support during a family conference (p < .001). Additional correlates with a higher QODD-1 score included use of standardized comfort care orders and occurrence of a family conference (p < or = .05).


CONCLUSIONS
We identified chart-based variables associated with higher QODD scores. These QODD scores could serve as targets for measuring and improving the quality of end-of-life care in the ICU.
Glavan
Bradford J
BJ
Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Washington, Seattle, WA, USA. bglavan@u.washington.edu
Engelberg
Ruth A
RA
Downey
Lois
L
Curtis
J Randall
JR
D001293:Attitude to Death; D003422:Critical Care / Q000145:classification*; D005190:Family / Q000523:psychology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008297:Male; D008499:Medical Records; D010166:Palliative Care / Q000379:methods* / Q000523:psychology / Q000706:statistics & numerical data; D011785:Quality Assurance, Health Care / Q000379:methods*; D011795:Surveys and Questionnaires