Transforming the mortality review conference to assess palliative care in the acute care setting: a feasibility study.
OBJECTIVE
This project sought to evaluate the impact of a hospital-based Palliative Care Consultation (PCC) service utilizing a common practice: the resident mortality review conference.


METHODS
Internal Medicine residents used a revised chart audit tool during the mortality review conference, which included domains described in the Clinical Practice Guidelines for Quality Palliative Care (2004). This study attempted to transform the common practice into a methodology for collecting data that could be used as a platform to assess the quality of hospital care near the end of life. In this review, the residents were asked not only "what care was delivered appropriately?" but "what could we have done?" to relieve the patient's and family's suffering.


RESULTS
The results showed that the mortality review process could be used to assess care at the end of life. It also showed that those patients who received a PCC received better care. Symptoms were addressed at a significantly higher rate for those patients who received a PCC than for those who did not. Specifically, these were symptoms of pain (75% vs. 51%, p < .0001), dyspnea (75% vs. 59%, p < 0.0001), nausea (28% vs. 18%, p < 0.0001), and agitation (53% vs. 33%, p < 0.0001).


CONCLUSIONS
The mortality review process was found to be valuable in assessing care delivery for patients near the end of life. The tool yielded results that were consistent with findings of other studies looking at pain and symptom management, advance care planning, and the rate of palliative care consults across major diagnostic categories, supporting the face validity of the mortality review process.
Pekmezaris
Renee
R
North Shore-Long Island Jewish Health System, Great Neck, New York 11021, USA. rpekmeza@nshs.edu
Cooper
Lynda
L
Efferen
Linda
L
Mastrangelo
Amy
A
Silver
Alan
A
Eichorn
Ann
A
Walia
Rajni
R
Mir
Tanveer
T
Liberman
Tara
T
Weiner
Joseph
J
Steinberg
Harry
H
D000368:Aged; D003422:Critical Care / Q000379:methods* / Q000592:standards; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D011785:Quality Assurance, Health Care; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods* / Q000592:standards