https://orcid.org/0000-0002-6174-6573
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Sophie Meesters, Aneta Schieferdecker, Sukhvir Kaur, Nikolas Oubaid, Anneke Ullrich, Karin Oechsle, Holger Schulz, Raymond Voltz, Kerstin Kremeike, Dying in hospital: a retrospective medical record analysis on care in the dying phase in intensive care units and general wards, International Journal for Quality in Health Care, Volume 37, Issue 2, 2025, mzaf025, https://doi.org/10.1093/intqhc/mzaf025
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Abstract
Background
Care in the dying phase is often suboptimal in hospitals outside specialized palliative care. Studies of the implementation of recommendations for care in the dying phase are rare. Medical records can provide information in this regard.
Methods
A retrospective analysis of medical records was conducted for 400 patients who died in six intensive care units (ICUs) and four general wards (GWs) at two German medical centres. To evaluate the care in the dying phase, we descriptively analysed 37 variables reflecting recommendations of the German Palliative Care Guideline. To identify factors associated with important aspects of care, seven of these variables were determined as appropriate for multiple logistic regression.
Results
In 299/400 (74.8%) patients, recognition of the dying phase was documented. Patients with the ability to communicate were informed about the impending death in 46/121 (38.0%) and informal caregivers (ICs) in 282/390 (72.3%). Patients’ wishes regarding care were documented in 33/122 (27.1%). Monitoring was rarely stopped before death, with significantly lower percentages in ICUs: e.g. vital signs in 30% [14.9% in ICUs vs. 52.9% in GWs; confidence interval (28.4, 47.6)]. Validated symptom assessment tools were used in 272/400 (68.0%), mainly for pain (66.3%). Logistic regression analysis identified setting (ICUs vs. GWs), recognition of the dying phase, patient age, communication ability, and malignant neoplasm as factors significantly associated with aspects of care.
Conclusion
The dying phase was not consistently documented, many presumably nonbeneficial interventions continued until death, systematic symptom assessment beyond pain was lacking, and communication with patients and ICs was poorly documented. Findings suggest a need for setting-specific strengthening of healthcare professionals in these settings.
