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Differences in end-of-life care in the ICU across patients cared for by medicine, surgery, neurology, and neurosurgery physicians.

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.

journal_name

Chest

journal_title

Chest

authors

Kross EK,Engelberg RA,Downey L,Cuschieri J,Hallman MR,Longstreth WT Jr,Tirschwell DL,Curtis JR

doi

10.1378/chest.13-1351

subject

Has Abstract

pub_date

2014-02-01 00:00:00

pages

313-321

issue

eissn

0012-3692

issn

1931-3543

pii

S0012-3692(15)34171-4

journal_volume

145

pub_type

杂志文章,多中心研究

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Differences in end-of-life care in the ICU across patients cared for by medicine, surgery, neurology, and neurosurgery physicians.