title: The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center.
abstract: BACKGROUND
  The quality of perimortem care received by patients who died at our hospitals was unknown.
  
  
  OBJECTIVE
  To describe the quality of hospital care experienced in the last week of life, as perceived by decedents' families.
  
  
  METHODS
  Telephone survey that included established measures and investigator-developed content.
  
  
  METHODS
  Large, tertiary care center known for high-quality, cost-effective care.
  
  
  METHODS
  Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year.
  
  
  METHODS
  None.
  
  
  METHODS
  Participant perceptions of the decedent's care, including symptom management, personal care, communication, and care coordination.
  
  
  RESULTS
  Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents' anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents' illness (29%), and receiving contradictory or confusing information (33%).
  
  
  CONCLUSIONS
  Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.
authors.affiliation: 1 Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Elise C
authors.initials: EC
authors.lastname: Carey
authors.affiliation: 2 Department of Nursing, Mayo Clinic, Rochester, MN, USA.
authors.forename: Ann M
authors.initials: AM
authors.lastname: Dose
authors.affiliation: 3 Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Humeniuk
authors.affiliation: 3 Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Yichen C
authors.initials: YC
authors.lastname: Kuan
authors.affiliation: 3 Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA.|4 Social Behavioral Education Research Institutional Review Board, Tufts University, Boston, MA, USA.
authors.forename: Ashley D
authors.initials: AD
authors.lastname: Hicks
authors.affiliation: 3 Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Abigale L
authors.initials: AL
authors.lastname: Ottenberg
authors.affiliation: 1 Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.|5 Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jon C
authors.initials: JC
authors.lastname: Tilburt
authors.affiliation: 6 Department of Social Behavioral Sciences, Institute for Health and Aging, University of California, San Francisco, CA, USA.|7 Department of Anthropology, History, and Social Medicine, University of California, San Francisco, CA, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Koenig
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration* / Q000592:standards; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003142:Communication; D003258:Consumer Behavior; D003643:Death; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration* / Q000523:psychology; D010465:Perception; D011787:Quality of Health Care / Q000458:organization & administration* / Q000592:standards; D013727:Terminal Care / Q000458:organization & administration* / Q000523:psychology
keywords: death; decedent; family caregivers; hospitals; quality of health care; terminal care