Improving the quality of care delivered to people imminently dying in hospital by implementing a care bundle: an observational before and after feasibility study

Abstract

Introduction

Most Australians die predictably in acute hospital settings. Despite this, hospitals remain ill-equipped to care for dying patients with hospital deaths not uncommonly perceived as distressing by both patients and their families. A care bundle for the dying was developed with this aiming to report the feasibility of implementing this quality improvement strategy.

Methods

A before and after observational approach was used to compare whether there were changes in care delivery to imminently dying patients in two medical wards. Data were extracted retrospectively from their inpatient files. The main outcome of this work was the percentage compliance with the bundle elements and proportional change from baseline where comparative care processes had previously been in place.

Results

Over 6 months, 90 deaths occurred with the bundle in place for 74.5% (n = 70) with significant increases in regular symptom monitoring and monitoring of family distress seen (p < 0.001, respectively). There was compliance with prescribing guideline for pain in 59.2% (29/49) charts and breathlessness in 53.1% (26/49). In the absence of previous prescribing guidelines it was not possible to comment on the significance of this latter observation.

Discussion

This work highlights that it is feasible to implement and assess a pilot project aimed at improving the quality of care delivered to people dying in acute hospitals. This preliminary work suggests that it is possible to integrate evidence-based care processes into the care of the dying by adopting a care paradigm more typically reserved for critical care. However, more work is required to confirm this in larger studies.