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Anales del Sistema Sanitario de Navarra
Print version ISSN 1137-6627
Abstract
GIRBAU, M.B.; MONEDERO, P.; CENTENO, C. and GRUPO ESPANOL DE CUIDADOS AL FINAL DE LA VIDA EN UCI. Good care for patients who die in intensive care units in Spain. A study based on international care quality indicators. Anales Sis San Navarra [online]. 2017, vol.40, n.3, pp.339-349. ISSN 1137-6627. https://dx.doi.org/10.23938/assn.0026.
Background.
To assess the quality of clinical care given to patients who die in intensive care units (ICU) in Spain.
Methodos.
A retrospective observational cohort study of patients who died in the ICU based on a Spanish sample. Inclusion criteria were patients older than 18 years who died in ICU after a minimum stay of 24 hours. Consecutive admissions without exclusions were analyzed. Excellence criteria in intensive care were assessed by quality indicators and measures, related to end-of-life care, developed by the Robert Wood Johnson Foundation Critical Care Workgroup.
Results.
Two hundred and eighty-two patients from 15 Spanish ICU were included. A median of 13% was observed in the achievement of the indicators. Almost all clinical records assessed both the patients’ decision making capacity (96%) and their communication with families (98%), while a plan of care goals was achieved in only 50% of them. Only two ICU had open visiting policies. Distress assessment (48%) was better than that of pain assessment (28%). The absence of protocol for the withdrawal of life-sustaining treatments was observed in thirteen ICU. The indicators of emotional and spiritual support were achieved in less than 10%.
Conclusions.
The quality of end-of-life care in the participating ICU needs to be improved. The study identifies shortcomings and indicates existing resources in clinical practice from which a gradual improvement plan, adapted to the situation in each hospital, can be designed. The analysis, inexpensive in its implementation, offers an opportunity for improvement, a goal recommended by most professional societies of intensive care medicine.
Keywords : End-of-life care; Intensive care; Critical care; Palliative care; Quality improvement.