Erin K Kross1, Ruth A Engelberg2, Lois Downey2, Joseph Cuschieri3, Matthew R Hallman4, W T Longstreth5, David L Tirschwell5, J Randall Curtis2. 1. Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA. Electronic address: ekross@uw.edu. 2. Division of Pulmonary & Critical Care Medicine, Department of Medicine, University of Washington, Harborview Medical Center, Seattle, WA. 3. Department of Surgery, University of Washington, Harborview Medical Center, Seattle, WA. 4. Department of Anesthesiology & Pain Medicine, University of Washington, Harborview Medical Center, Seattle, WA. 5. Department of Neurology, University of Washington, Harborview Medical Center, Seattle, WA.
Abstract
BACKGROUND: Some of the challenges in the delivery of high-quality end-of-life care in the ICU include the variability in the characteristics of patients with certain illnesses and the practice of critical care by different specialties. METHODS: We examined whether ICU attending specialty was associated with quality of end-of-life care by using data from a clustered randomized trial of 14 hospitals. Patients died in the ICU or within 30 h of transfer and were categorized by specialty of the attending physician at time of death (medicine, surgery, neurology, or neurosurgery). Outcomes included family ratings of satisfaction, family and nurse ratings of quality of dying, and documentation of palliative care in medical records. Associations were tested using multipredictor regression models adjusted for hospital site and for patient, family, or nurse characteristics. RESULTS:Of 3,124 patients, the majority were cared for by an attending physician specializing in medicine (78%), with fewer from surgery (12%), neurology (3%), and neurosurgery (6%). Family satisfaction did not vary by attending specialty. Patients with neurology or neurosurgery attending physicians had higher family and nurse ratings of quality of dying than patients of attending physicians specializing in medicine (P < .05). Patients with surgery attending physicians had lower nurse ratings of quality of dying than patients with medicine attending physicians (P < .05). Chart documentation of indicators of palliative care differed by attending specialty. CONCLUSIONS:Patients cared for by neurology and neurosurgery attending physicians have higher family and nurse ratings of quality of dying than patients cared for by medicine attending physicians and have a different pattern of indicators of palliative care. Patients with surgery attending physicians had fewer documented indicators of palliative care. These findings may provide insights into potential ways to improve the quality of dying for all patients. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00685893; URL: www.clinicaltrials.gov.
RCT Entities:
BACKGROUND: Some of the challenges in the delivery of high-quality end-of-life care in the ICU include the variability in the characteristics of patients with certain illnesses and the practice of critical care by different specialties. METHODS: We examined whether ICU attending specialty was associated with quality of end-of-life care by using data from a clustered randomized trial of 14 hospitals. Patients died in the ICU or within 30 h of transfer and were categorized by specialty of the attending physician at time of death (medicine, surgery, neurology, or neurosurgery). Outcomes included family ratings of satisfaction, family and nurse ratings of quality of dying, and documentation of palliative care in medical records. Associations were tested using multipredictor regression models adjusted for hospital site and for patient, family, or nurse characteristics. RESULTS: Of 3,124 patients, the majority were cared for by an attending physician specializing in medicine (78%), with fewer from surgery (12%), neurology (3%), and neurosurgery (6%). Family satisfaction did not vary by attending specialty. Patients with neurology or neurosurgery attending physicians had higher family and nurse ratings of quality of dying than patients of attending physicians specializing in medicine (P < .05). Patients with surgery attending physicians had lower nurse ratings of quality of dying than patients with medicine attending physicians (P < .05). Chart documentation of indicators of palliative care differed by attending specialty. CONCLUSIONS:Patients cared for by neurology and neurosurgery attending physicians have higher family and nurse ratings of quality of dying than patients cared for by medicine attending physicians and have a different pattern of indicators of palliative care. Patients with surgery attending physicians had fewer documented indicators of palliative care. These findings may provide insights into potential ways to improve the quality of dying for all patients. TRIAL REGISTRY: ClinicalTrials.gov; No.: NCT00685893; URL: www.clinicaltrials.gov.
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