title: Transforming the mortality review conference to assess palliative care in the acute care setting: a feasibility study.
abstract: 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.
authors.affiliation: North Shore-Long Island Jewish Health System, Great Neck, New York 11021, USA. rpekmeza@nshs.edu
authors.forename: Renee
authors.initials: R
authors.lastname: Pekmezaris
authors.forename: Lynda
authors.initials: L
authors.lastname: Cooper
authors.forename: Linda
authors.initials: L
authors.lastname: Efferen
authors.forename: Amy
authors.initials: A
authors.lastname: Mastrangelo
authors.forename: Alan
authors.initials: A
authors.lastname: Silver
authors.forename: Ann
authors.initials: A
authors.lastname: Eichorn
authors.forename: Rajni
authors.initials: R
authors.lastname: Walia
authors.forename: Tanveer
authors.initials: T
authors.lastname: Mir
authors.forename: Tara
authors.initials: T
authors.lastname: Liberman
authors.forename: Joseph
authors.initials: J
authors.lastname: Weiner
authors.forename: Harry
authors.initials: H
authors.lastname: Steinberg
mesh_terms: 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