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Transforming the mortality review conference to assess palliative care in the acute care setting: A feasibility study

Published online by Cambridge University Press:  28 September 2010

Renee Pekmezaris ,
Lynda Cooper ,
Linda Efferen ,
Amy Mastrangelo ,
Alan Silver ,
Ann Eichorn ,
Rajni Walia ,
Tanveer Mir ,
Tara Liberman  and
Joseph Weiner
...Show all authors
Renee Pekmezaris*
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York The Bette and Jerome Lorber Center for the Advancement of Medical Education, New Hyde Park, New York The Feinstein Institute for Medical Research, Manhasset, New York Albert Einstein College of Medicine, Bronx, New York
Lynda Cooper
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York
Linda Efferen
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York The Bette and Jerome Lorber Center for the Advancement of Medical Education, New Hyde Park, New York Albert Einstein College of Medicine, Bronx, New York
Amy Mastrangelo
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York The Bette and Jerome Lorber Center for the Advancement of Medical Education, New Hyde Park, New York Albert Einstein College of Medicine, Bronx, New York
Alan Silver
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York The Bette and Jerome Lorber Center for the Advancement of Medical Education, New Hyde Park, New York Albert Einstein College of Medicine, Bronx, New York
Ann Eichorn
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York
Rajni Walia
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York
Tanveer Mir
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York
Tara Liberman
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York
Joseph Weiner
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York Albert Einstein College of Medicine, Bronx, New York
Harry Steinberg
Affiliation:
North Shore-Long Island Jewish Health System, Great Neck, New York The Bette and Jerome Lorber Center for the Advancement of Medical Education, New Hyde Park, New York The Feinstein Institute for Medical Research, Manhasset, New York Albert Einstein College of Medicine, Bronx, New York
*
Address correspondence and reprint requests to: Renee Pekmezaris, North Shore Long Island Jewish Health System, 175 Community Drive, Second Floor, Great Neck, NY 11021. E-mail: rpekmeza@nshs.edu
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Abstract

Objective:

This project sought to evaluate the impact of a hospital-based Palliative Care Consultation (PCC) service utilizing a common practice: the resident mortality review conference.

Method:

Internal Medicine residents used a revised chart audit tool during the mortality review conference, which included domains described in the Clinical Practice Guidelines for Quality Palliative Care (2004). This study attempted to transform the common practice into a methodology for collecting data that could be used as a platform to assess the quality of hospital care near the end of life. In this review, the residents were asked not only “what care was delivered appropriately?” but “what could we have done?” to relieve the patient's and family's suffering.

Results:

The results showed that the mortality review process could be used to assess care at the end of life. It also showed that those patients who received a PCC received better care. Symptoms were addressed at a significantly higher rate for those patients who received a PCC than for those who did not. Specifically, these were symptoms of pain (75% vs. 51%, p <.0001), dyspnea (75% vs. 59%, p < 0.0001), nausea (28% vs. 18%, p < 0.0001), and agitation (53% vs. 33%, p < 0.0001).

Significance of results:

The mortality review process was found to be valuable in assessing care delivery for patients near the end of life. The tool yielded results that were consistent with findings of other studies looking at pain and symptom management, advance care planning, and the rate of palliative care consults across major diagnostic categories, supporting the face validity of the mortality review process.

Keywords

Mortality reviewPalliative care consultationEvaluation
Type
Original Articles
Information
Palliative & Supportive Care , Volume 8 , Issue 4 , December 2010 , pp. 421 - 426
Copyright
Copyright © Cambridge University Press 2010

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