Dying in a West Virginia acute care hospital: what is it like?

To gain insight into the demographics and experiences of dying patients in a West Virginia acute care hospital, a chart review was conducted of all patients dying over a four-week period in 1997. Most of these patients were usually older with chronic progressive diseases. Half the patients underwent life-sustaining treatment in the last three days of life, and most patients had multiple nonpalliative interventions during this period. Interventions were refused or requested to be stopped by patients or families in over one third of the cases. A poor expected outcome was documented for more than two-thirds of the group. Do-Not-Resuscitate orders were written for most patients often within three days of death. Pain assessment was poorly documented. These findings are consistent with other studies of the hospitalized dying. Reasons for the continuation of non-palliative measures in the terminally ill are explored. Incorporation of palliative care programs into the hospital setting is recommended as a means to improve end-of-life care.