title: Has there been any progress in improving the quality of hospitalised death? Replication of a US chart audit study.
abstract: OBJECTIVE
  To describe the experience of dying in a US tertiary academic medical centre and to compare this experience with a historical decedent sample.
  
  
  METHODS
  A retrospective, observational, chart audit study of adults (N=159) who died in hospital.
  
  
  METHODS
  Component hospitals of the Dartmouth-Hitchcock Medical Center: Mary Hitchcock Memorial Hospital (MHMH), Lebanon, New Hampshire, and the affiliated Veteran's Affairs Medical Center (VAMC), White River Junction, Vermont.
  
  
  METHODS
  159 hospitalised adult decedents comprising a random sample of 100 MHMH decedents and a total sample of 59 VAMC decedents.
  
  
  METHODS
  The authors compared end-of-life (EOL) care in decedents who had a palliative care consultation (PCC) with those who did not. An exploratory analysis compared the EOL care between the 2008 decedent sample and an historical decedent sample (N=104).
  
  
  RESULTS
  63 of 159 inpatients received a PCC. Decedents receiving a PCC were less likely to die in an intensive care unit, had fewer invasive interventions (eg, intubation, assisted ventilation, dialysis, chemotherapy) and were more likely to have advance directives, do-not-resuscitate orders and comfort measures orders than those who did not receive a PCC. Higher rates of emotional and pastoral care were also noted. Compared with the historical sample, 2008 decedents had a higher rate of invasive interventions, but fewer invasive interventions were noted in the 2008 PCC subsample.
  
  
  CONCLUSIONS
  Less invasive EOL care was observed in decedents who received a PCC. Ongoing monitoring of EOL care is critically important for hospital quality improvement programmes.
authors.affiliation: Dartmouth Medical School, Hanover, New Hampshire, USA.
authors.forename: Purak
authors.initials: P
authors.lastname: Parikh
authors.forename: Frances C
authors.initials: FC
authors.lastname: Brokaw
authors.forename: Shagun
authors.initials: S
authors.lastname: Saggar
authors.forename: Luann
authors.initials: L
authors.lastname: Graves
authors.forename: Stefan
authors.initials: S
authors.lastname: Balan
authors.forename: Zhongze
authors.initials: Z
authors.lastname: Li
authors.forename: Tor D
authors.initials: TD
authors.lastname: Tosteson
authors.forename: Marie
authors.initials: M
authors.lastname: Bakitas
mesh_terms: D000046:Academic Medical Centers; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D058996:Quality Improvement; D012017:Referral and Consultation; D012189:Retrospective Studies; D013727:Terminal Care; D062606:Tertiary Care Centers; D014481:United States