title: Impact of a palliative care initiative on end-of-life care in the general wards: a before-and-after study.
abstract: BACKGROUND
  Data on deaths in the general wards of our hospital in 2007 revealed infrequent discussions on end-of-life care and excessive burdensome interventions.
  
  
  OBJECTIVE
  A physician order form to withhold inappropriate life-sustaining interventions was initiated in 2009. The use of the form was facilitated by staff educational sessions and a palliative care consult service. This study aims to evaluate the impact of these interventions in 2010.
  
  
  METHODS
  Retrospective medical chart review with comparisons was made for the following: baseline patient characteristics, orders concerning life-sustaining therapies, treatment provided in last 24 h of life, and discussion of specific life-sustaining therapies with patients and families.
  
  
  METHODS
  This study included all adult patients who died in our hospital's general wards in 2007 (N = 683) versus 2010 (N = 714).
  
  
  RESULTS
  There was an increase in orders to withhold life-sustaining therapies, such as cardiopulmonary resuscitation (66.2%-80.0%). There was a decrease in burdensome interventions such as antibiotics (44.9%-24.9%) and a small increase in palliative treatments such as analgesia (29.1%-36.7%). There were more discussions on the role of cardiopulmonary resuscitation with conversant patients (4.6%-10.2%) and families (56.5%-79.8%) (p-value all < 0.05). On multivariate analysis, the physician order form independently predicted orders to withhold cardiopulmonary resuscitation.
  
  
  CONCLUSIONS
  A multifaceted intervention of a physician order form, educational sessions, and palliative care consult service led to an improvement in documentation of end-of-life discussions and was associated with an increase in such discussions and less burdensome treatments. There were small improvements in the proportion of palliative treatments administered.
authors: 1Department of Medicine, Alexandra Hospital (Jurong Health Services), Singapore.
authors: Adeline
authors: A
authors: Tan
authors: Angeline
authors: A
authors: Seah
authors: Gerald
authors: G
authors: Chua
authors: Tow Keang
authors: TK
authors: Lim
authors: Jason
authors: J
authors: Phua
mesh_terms: D032722:Advance Care Planning / Q000592:standards*; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy; D054869:Clinical Audit; D015897:Comorbidity; D005260:Female; D005568:Forms and Records Control; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008020:Life Support Care / Q000379:methods* / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D010166:Palliative Care; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D015397:Program Evaluation; D016414:Resuscitation Orders; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology; D012923:Social Class; D028761:Withholding Treatment / Q000706:statistics & numerical data
keywords: Asian; Do-not-resuscitate orders; general wards; palliative care