Even top-flight hospitals like UCLA Medical Center can improve the way they manage dying patients, according to a study in Archives of Internal Medicine.

Researchers found that the doctors were excellent at pain control, but did less well in discussing prognosis and goals of care with patients and families. Although they performed well in ordering comfort care, they did less well at follow-up to make sure the care was effective.
The head of the study, Dr Anne Walling, of the University of California Los Angeles, and her collaborators analysed the charts of 496 adults hospitalised at least three days before dying. The patients’ end-of-life care was assessed based on 13 quality indicators in three areas: eliciting goals of care, pain assessment and management, and assessment and management of dyspnea (difficulty in breathing).

Patients received recommended care for 70% of the quality indicators. Goals of care were addressed in a timely manner about half the time, pain assessments were performed 94% of the time, and pain treatments (95%) and dyspnea treatments (87%) were administered as recommended.

Follow-up for distressing symptoms, however, was not performed as well as initial assessments, and only 29% of patients whose ventilation tubes were removed before death were evaluated for dyspnea. "The findings suggest much room for improvement in treating patients dying in the hospital," the investigators concluded. ~Reuters, Jul 8