Quality of dying in a New Zealand teaching hospital

Studies suggest that there is a need to improve the way we deliver care at the end of life. Based on recommendations from end-of-life experts, metrics were identified to measure the quality of dying in Dunedin Hospital.

A retrospective observational study was performed to assess the care provided to patients who died in the hospital in 2003.

Dunedin Hospital is a 350-bed tertiary care teaching hospital located in the South Island of New Zealand.

Medical records of 200 consecutive decedents were reviewed to evaluate communication, interventions, and symptom control during their terminal hospitalisation.

Mean hospital length-of-stay was 8 days; 38 patients (19%) died following an ICU admission. There was documentation of end-of-life discussion with either the patient or the family in 164 patients (82%). 74% had a DNR order. Pain status was documented in 140 patients (70%); 134 of these patients were pain-free.

Overall, the results suggest that the ideals in end-of-life care pertaining to pain control, communication and avoidance of unnecessary interventions were achieved in a majority of the decedents during the study period. The socialised healthcare system, the availability of resources, societal expectations and a lack of a litigious environment are theorised to positively influence end-of-life care delivery in New Zealand.