Rationale:
We investigated whether proposed “quality markers” within the medical record are associated with family assessment of the quality of dying and death in the intensive care unit (ICU).
Objective:
To identify chart-based markers that could be used as measures for improving the quality of end-of-life care.
Design:
A multicenter study conducting standardized chart abstraction and surveying families of patients who died in the ICU or within 24 hrs of being transferred from an ICU.
Setting:
ICUs at ten hospitals in the northwest United States.
Patients:
Overall, 356 patients who died in the ICU or within 24 hrs of transfer from an ICU.
Measurements:
The 22-item family assessed Quality of Dying and Death (QODD-22) questionnaire and a single item rating of the overall quality of dying and death (QODD-1).
Analysis:
The associations of chart-based quality markers with QODD scores were tested using Mann-Whitney U tests, Kruskal-Wallis tests, or Spearman's rank-correlation coefficients as appropriate.
Results:
Higher QODD-22 scores were associated with documentation of a living will (p = .03), absence of cardiopulmonary resuscitation performed in the last hour of life (p = .01), withdrawal of tube feeding (p = .04), family presence at time of death (p = .02), and discussion of the patient's wish to withdraw life support during a family conference (p < .001). Additional correlates with a higher QODD-1 score included use of standardized comfort care orders and occurrence of a family conference (p ≤ .05).
Conclusions:
We identified chart-based variables associated with higher QODD scores. These QODD scores could serve as targets for measuring and improving the quality of end-of-life care in the ICU.
