title: Quality of documented consent for the de-escalation of care on a general and trauma surgery service.
abstract: Postoperative and posttrauma mortality in the acute care setting often occurs after a decision for de-escalation of care. It is important that the quality of consent for de-escalation of care is maintained to ensure patient autonomy. This retrospective review aims to determine the quality  of the consent process for care de-escalation in patients on a trauma and general surgery service who sustained in-hospital mortality. One hundred thirty-three patients (99 trauma) were identified who died in 1 year. Of these patient deaths, 80 (60%) involved de-escalation of care. In three  (3%) cases, there were no documented discussions for de-escalation consent. Of the remaining cases, documentation was considered optimal 21 per cent of the time. Only nine (11%) patients were able to participate in a discussion of their end-of-life care. The other 23 patients who were initially  competent lost their ability to participate in discussions after a debilitating event. In this study, the majority of patients who died on a surgical service underwent a de-escalation of care. The documentation quality was suboptimal in most cases. Earlier and more thorough discussion of the  patient's end-of-life wishes may improve the de-escalation of care consent process.
authors.affiliation: Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA. jrt3md@gmail.com
authors.forename: Joseph
authors.initials: J
authors.lastname: Thomasson
authors.forename: Tommy
authors.initials: T
authors.lastname: Petros
authors.forename: Shauna
authors.initials: S
authors.lastname: Lorenzo-Rivero
authors.forename: Richard A
authors.initials: RA
authors.lastname: Moore
authors.forename: J Daniel
authors.initials: JD
authors.lastname: Stanley
mesh_terms: D000328:Adult; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007258:Informed Consent / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative; D028761:Withholding Treatment / Q000592:standards*; D014947:Wounds and Injuries / Q000601:surgery; D055815:Young Adult