Quality assessments of the quality of dying and death by medical record review for patients dying in intensive care units in China

Abstract

Abstract Objective: This study aimed to assess the intensity of life-sustaining therapies and end-stage symptom management within 24 hours preceding death among patients in the intensive care unit. Methods: A retrospective analysis was conducted on the medical records of 131 deceased patients in the comprehensive intensive care unit of XXX hospital, spanning from January to June 2019. Results: Among the patients examined, 76.33% received comprehensive life support until their demise, with the majority undergoing continuous life support measures. In the 24-hour period prior to their death, 76.34% of patients were intubated, 74.81% underwent invasive mechanical ventilation, 29.01% received cardiopulmonary resuscitation, and 19.85% underwent continuous blood purification. Furthermore, 87.02% of terminally ill patients were administered vasoactive drugs, while 56.49% utilized analgesics. The mean hospitalization expense totaled $2,724.11. Conclusion: This retrospective analysis underscores the prevalent use of invasive treatments, even during the final stages of life among intensive care unit patients in mainland China. The quality of death in these cases appears suboptimal. Implementing appropriate strategies for the withdrawal of non-beneficial life-sustaining treatments and integrating active hospice care is imperative to improve end-of-life care for these patients. Implications for Clinical Nursing: Employing a quantitative approach highlights the significance of evaluating both the measures and intensity of life-sustaining therapy, as well as the actual situation regarding end-stage symptom management within 24 hours before death among patients in the intensive care unit. This underscores the necessity for further research in this domain. The study's findings offer compelling evidence that advocates for the establishment of hospice programs aimed at enhancing the quality of dying and death among patients in mainland China.