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Quality of dying in a New Zealand teaching hospital
  1. J L Glasgow1,
  2. S R McLennan2,
  3. K J High1,
  4. L A G Celi1
  1. 1
    Department of Anaesthesia, Intensive Care and Pain Medicine, Dunedin Hospital, Dunedin, New Zealand
  2. 2
    Bioethics Centre, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  1. L A Celi, Laboratory of Computer Science, Massachusetts General Hospital, 50 Staniford Street, Boston, MA 02114, USA; leo_celi{at}hms.harvard.edu

Abstract

Objective: 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.

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

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

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

Results: 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.

Conclusion: 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.

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Footnotes

  • Competing interests: None.

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