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Related Experiment Videos

Death in the hospital

S J Goodlin1, G S Winzelberg, J M Teno

  • 1White River Junction Veterans Affairs Medical Center, VT, USA.

Archives of Internal Medicine
|July 29, 1998
PubMed
Summary

This study reviewed medical records of dying patients, finding that comfort measures only (CMO) orders led to less aggressive care but lacked specific comfort care processes. Improvement in end-of-life care requires evaluating care processes.

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Area of Science:

  • Medical record review
  • Palliative care research
  • End-of-life symptom management

Background:

  • Hospitalized adults nearing end-of-life experience various symptoms.
  • Understanding current treatments and interventions is crucial for improving care.

Purpose of the Study:

  • To examine symptoms and treatments in hospitalized adults during the final 2 days of life.
  • To assess the impact of "comfort measures only" (CMO) orders on care.

Main Methods:

  • Retrospective review of 104 consecutive medical records from academic and Veterans Affairs hospitals.
  • Examination of documented symptoms, treatments, and life-sustaining intervention limitations.

Main Results:

  • Pain, dyspnea, and agitation were common in the last 48 hours of life.
Keywords:
Death and EuthanasiaEmpirical ApproachMary Hitchcock Memorial Hospital (Lebanon, NH)White River Junction Veterans Affairs Medical Center (VT)

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  • Patients with CMO orders received less intensive care (fewer ICU admissions, less ventilatory support, antibiotics).
  • CMO patients experienced similar symptom burdens to those without CMO orders.

    • Conclusions:

    • Retrospective chart review provides baseline data for end-of-life care improvement.
    • While CMO orders reduce aggressive interventions, specific comfort care processes are not consistently applied.
    • Systematic evaluation and testing of care processes are necessary to enhance care for dying patients.