Determinants of care outcomes for patients who die in hospital in Ireland: a retrospective study.
BACKGROUND
More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008/9. The study was undertaken as part of the Irish Hospice Foundation's Hospice Friendly Hospitals Programme (2007-2012).


METHODS
Outcomes of care were assessed by nurses, doctors and relatives who cared for the patient during the last week of life. Multi-level modelling was used to analyse how care outcomes were influenced by care inputs.


RESULTS
The sample of 999 patients represents 10% of acute hospital deaths and 29% of community hospital deaths in Ireland in 2008/9. Five care outcomes were assessed for each patient: symptom experience, symptom management, patient care, acceptability of the way patient died, family support. Care outcomes during the last week of life tended to be better when: the patient had cancer; admission to hospital was planned rather than emergency; death occurred in a single room or where privacy, dignity and environment of the ward was better; team meetings were held; there was good communication with patients and relatives; relatives were facilitated to stay overnight and were present at the time of death; nursing staff were experienced and had training in end-of-life care; the hospital had specific objectives for developing end-of-life care in its service plan.


CONCLUSIONS
The study shows significant differences in how care outcomes, including pain, were assessed by nurses, doctors and relatives. Care inputs operate in a mutually reinforcing manner to generate care outcomes which implies that improvements in one area are likely to have spill-over effects in others. Building on these findings, the Irish Hospice Foundation has developed an audit and review system to support quality improvement in all care settings where people die.
Social and Economic Research Consultant, 16 Hollybank Road, Dublin, Ireland. kieran@kieranmckeown.ie.
Kieran
K
McKeown
Social and Economic Consultant, Dublin, Ireland. mail@trutzhaase.eu.
Trutz
T
Haase
Research Fellow, Department of Economics and Statistics, University of Salerno, Salerno, Italy. jpratschke@unisa.it.
Jonathan
J
Pratschke
Specialist Palliative Care Nurse, Health Service Executive, Wexford, Ireland. saberm@eircom.net.
Shelagh
S
Twomey
Senior Utilization Officer, Sheikh Khalifa General Hospital, Abu Dhabi, United Arab Emirates. hdonovan21@gmail.com.
Helen
H
Donovan
Research Assistant, Lisbon, Portugal. feline.engling@gmail.com.
Feline
F
Engling
D001291:Attitude of Health Personnel; D003142:Communication; D004777:Environment; D005190:Family / Q000523:psychology*; D017051:Hospice Care / Q000458:organization & administration / Q000523:psychology; D006739:Hospital Administration; D006801:Humans; D007494:Ireland; D017063:Outcome Assessment, Health Care; D059408:Pain Management / Q000379:methods; D010166:Palliative Care / Q000458:organization & administration / Q000523:psychology; D005791:Patient Care / Q000523:psychology*; D010348:Patient Care Team; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration* / Q000523:psychology* / Q000592:standards