The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center

The quality of perimortem care received by patients who died at our hospitals was unknown.

To describe the quality of hospital care experienced in the last week of life, as perceived by decedents' families.

Telephone survey that included established measures and investigator-developed content.

Large, tertiary care center known for high-quality, cost-effective care.

Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year.

None.

Participant perceptions of the decedent's care, including symptom management, personal care, communication, and care coordination.

Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents' anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents' illness (29%), and receiving contradictory or confusing information (33%).

Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.