Critical care medicine, Apr 2008, vol. 36, no. 4

Not euthanasia, simply compassionate clinical care.
Full text available at OVID for NHS
p. 1387-8; author reply 1389
Truog-Robert-D.
Comment, Letter.
Comment
Comment on: Crit Care Med. 2007 Oct; 35(10):2428-30.

The search for a good death--are there quality insights accessible from medical records?
Full text available at OVID for NHS
p. 1372-3
Mularski-Richard-A.
Comment, Editorial.
Comment
Comment on: Crit Care Med. 2008 Apr; 36(4):1138-46.

Using the medical record to evaluate the quality of end-of-life care in the intensive care unit.
Full text available at OVID for NHS
p. 1138-46
Glavan-Bradford-J, Engelberg-Ruth-A, Downey-Lois, Curtis-J-Randall.
Abstract
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 < or = .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.