Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025
Documentation and evaluation of care of dying patients.
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de Freitas Maria, Roberts Lucinda, Cockroft Alexandra, Duke Graeme
Аннотация
OBJECTIVE: Evaluate the quality of documentation and delivery of EOLC in the Intensive Care Unit (ICU) during the COVID-19 pandemic and compare with a pre-pandemic audit.
DESIGN: Retrospective clinical audit of medical records of patients who died in ICU during the COVID-19 pandemic, January 2021 to February 2022, using the Documentation and Evaluation of Care of Dying Equation (DECODE) survey tool.
SETTING: Three metropolitan adult ICUs in Victoria, Australia.
MAIN OUTCOMES: DECODE audit score, patient characteristics, demographics, end of life planning, quality of death indicators, management of dying.
RESULTS: There were 194 deaths over a 14-month period. 2 cases were excluded. Patients wishes were documented in 83 (43%) cases. A total of 175 patients (91%) were receiving active treatment 24 h before death. A total of 166 deaths (86%) were expected and occurred a mean of 4.5 (IQR 2-9) days from admission to ICU. A total of 52 (27%) had palliative or symptom control care plans. The median DECODE score was 14 (IQR 12-15) with statistical variation across the three sites (p=0.001). Compared to pre pandemic audits, the DECODE score was higher (p=0.001) despite pandemic restrictions.
CONCLUSION: EOLC in ICU remains challenging due to diagnostic dilemmas, prognostic uncertainty, and short time-frames. Assessment of quality of EoLC care helps assess and possibly improve provision of care. The DECODE questionnaire provides a semi-objective measure of quality of care provided to the dying patient in ICU.
DESIGN: Retrospective clinical audit of medical records of patients who died in ICU during the COVID-19 pandemic, January 2021 to February 2022, using the Documentation and Evaluation of Care of Dying Equation (DECODE) survey tool.
SETTING: Three metropolitan adult ICUs in Victoria, Australia.
MAIN OUTCOMES: DECODE audit score, patient characteristics, demographics, end of life planning, quality of death indicators, management of dying.
RESULTS: There were 194 deaths over a 14-month period. 2 cases were excluded. Patients wishes were documented in 83 (43%) cases. A total of 175 patients (91%) were receiving active treatment 24 h before death. A total of 166 deaths (86%) were expected and occurred a mean of 4.5 (IQR 2-9) days from admission to ICU. A total of 52 (27%) had palliative or symptom control care plans. The median DECODE score was 14 (IQR 12-15) with statistical variation across the three sites (p=0.001). Compared to pre pandemic audits, the DECODE score was higher (p=0.001) despite pandemic restrictions.
CONCLUSION: EOLC in ICU remains challenging due to diagnostic dilemmas, prognostic uncertainty, and short time-frames. Assessment of quality of EoLC care helps assess and possibly improve provision of care. The DECODE questionnaire provides a semi-objective measure of quality of care provided to the dying patient in ICU.