• Bradford J Glavan, Ruth A Engelberg, Lois Downey, and CurtisJ RandallJR.
• Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Washington, Seattle, WA, USA. bglavan@u.washington.edu
• Crit. Care Med. 2008 Apr 1; 36 (4): 113811461138-46.

RationaleWe investigated whether proposed "quality markers" within the medical record are associated with family assessment of the quality of dying and death in the intensive care unit (ICU).ObjectiveTo identify chart-based markers that could be used as measures for improving the quality of end-of-life care.DesignA multicenter study conducting standardized chart abstraction and surveying families of patients who died in the ICU or within 24 hrs of being transferred from an ICU.SettingICUs at ten hospitals in the northwest United States.PatientsOverall, 356 patients who died in the ICU or within 24 hrs of transfer from an ICU.MeasurementsThe 22-item family assessed Quality of Dying and Death (QODD-22) questionnaire and a single item rating of the overall quality of dying and death (QODD-1).AnalysisThe associations of chart-based quality markers with QODD scores were tested using Mann-Whitney U tests, Kruskal-Wallis tests, or Spearman's rank-correlation coefficients as appropriate.ResultsHigher QODD-22 scores were associated with documentation of a living will (p = .03), absence of cardiopulmonary resuscitation performed in the last hour of life (p = .01), withdrawal of tube feeding (p = .04), family presence at time of death (p = .02), and discussion of the patient's wish to withdraw life support during a family conference (p < .001). Additional correlates with a higher QODD-1 score included use of standardized comfort care orders and occurrence of a family conference (p < or = .05).ConclusionsWe identified chart-based variables associated with higher QODD scores. These QODD scores could serve as targets for measuring and improving the quality of end-of-life care in the ICU.

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