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An audit of perioperative end-of-life care practices and documentation relating to patients who died in a surgical unit in three Victorian hospitals.

Authors
  • Keon-Cohen, Zoe M1, 2, 3
  • Story, David A3, 4
  • Moran, Juli A5
  • Jones, Daryl A2, 6
  • 1 Department of Anaesthesia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia. , (Australia)
  • 2 Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia. , (Australia)
  • 3 Anaesthesia Department, Austin Health, Australia. , (Australia)
  • 4 Department of Critical Care, University of Melbourne, Melbourne, Australia. , (Australia)
  • 5 Department of Palliative Care, Austin Health, Australia. , (Australia)
  • 6 Intensive Care Unit, Austin Health, Australia. , (Australia)
Type
Published Article
Journal
Anaesthesia and intensive care
Publication Date
May 01, 2022
Volume
50
Issue
3
Pages
234–242
Identifiers
DOI: 10.1177/0310057X211032652
PMID: 35301860
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The number of older, frail patients undergoing surgery is increasing, prompting consideration of the benefits of intensive treatment. Despite collaborative decision-making processes such as advance care planning being supported by recent Australian legislation, their role in perioperative care is yet to be defined. Furthermore, there has been little evaluation of the quality of end-of-life care in the surgical population. We investigated documentation of the premorbid functional status, severity of illness, intensity of treatment, operative management and quality of end-of-life care in patients who died in a surgical unit, with a retrospective study of surgical mortality which was performed across three hospitals over a 23-month period in Victoria, Australia. Among 99 deceased patients in the study cohort, 68 had a surgical operation. Preoperative functional risk assessment by medical staff was infrequently documented in the medical notes (5%) compared with activities of daily living (69%) documented by nursing staff. Documented preoperative discussions regarding the risk of death were rarely and inconsistently done, but when done were extensive. Documented end-of-life care discussions were identified in 71%, but were frequently brief, inconsistent, and in 60% did not occur until 48 hours from death. In 35.4% of instances, documented discussions involved junior staff (registrars or residents), and 43.4% involved intensive care unit staff. Palliative or terminal care referrals also occurred late (1-2 days prior to death). Not-for-resuscitation orders were frequently changed when approaching the end of life. Overall, 57% of deceased patients had a documented opportunity for farewell with family. We conclude that discussions and documentation of end-of-life care practices could be improved and recommend that all surgical units undertake similar audits to ensure that end-of-life care discussions occur for high-risk and palliative care surgical patients and are documented appropriately.

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