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01.12.2015 | Research article | Ausgabe 1/2015 Open Access

BMC Palliative Care 1/2015

Determinants of care outcomes for patients who die in hospital in Ireland: a retrospective study

Zeitschrift:
BMC Palliative Care > Ausgabe 1/2015
Autoren:
Kieran McKeown, Trutz Haase, Jonathan Pratschke, Shelagh Twomey, Helen Donovan, Feline Engling
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12904-015-0014-2) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

KMcK created the study, wrote the research manual, designed the questionnaires and sampling procedures, obtained ethical approval, supervised data collection and wrote the reports including this article. TH and JP did the statistical analysis and advised on sampling procedures and interpretation of results. ST managed the data collection and contributed to questionnaire design. HD contributed to questionnaire design. FE assisted with data analysis. All authors read and approved the final manuscript.

Abstract

Background

More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008/9. The study was undertaken as part of the Irish Hospice Foundation’s Hospice Friendly Hospitals Programme (2007–2012).

Methods

Outcomes of care were assessed by nurses, doctors and relatives who cared for the patient during the last week of life. Multi-level modelling was used to analyse how care outcomes were influenced by care inputs.

Results

The sample of 999 patients represents 10% of acute hospital deaths and 29% of community hospital deaths in Ireland in 2008/9. Five care outcomes were assessed for each patient: symptom experience, symptom management, patient care, acceptability of the way patient died, family support. Care outcomes during the last week of life tended to be better when: the patient had cancer; admission to hospital was planned rather than emergency; death occurred in a single room or where privacy, dignity and environment of the ward was better; team meetings were held; there was good communication with patients and relatives; relatives were facilitated to stay overnight and were present at the time of death; nursing staff were experienced and had training in end-of-life care; the hospital had specific objectives for developing end-of-life care in its service plan.

Conclusions

The study shows significant differences in how care outcomes, including pain, were assessed by nurses, doctors and relatives. Care inputs operate in a mutually reinforcing manner to generate care outcomes which implies that improvements in one area are likely to have spill-over effects in others. Building on these findings, the Irish Hospice Foundation has developed an audit and review system to support quality improvement in all care settings where people die.
Zusatzmaterial
Additional file 1: Manual for the study.
12904_2015_14_MOESM1_ESM.pdf
Additional file 2: Statistically significant (p < .05) relationships between care inputs and care outcomes.
12904_2015_14_MOESM2_ESM.docx
Literatur
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