Can "Palliative Care Reports" improve end-of-life care for hospitalized patients?

Improvement in the care of dying hospitalized patients was sought by providing evaluative feedback to individual physicians (n = 46) and nurses in three biannual "Palliative Care Reports." Hospitalized adult patients (n = 194) for whom "death was probable" were prospectively identified from the critical care or geriatric services, and a "palliative care" social work evaluation provided. Educational sessions on palliative care were held for physicians and nurses. Medical record review and family interviews were used to generate 10 scores per patient, which evaluated satisfaction with care, relief of symptoms (pain, dyspnea, gastrointestinal, psychological), and the timeliness of care planning. Subjective comments from a quality improvement committee and focussed educational material was also included. Despite these efforts, no change in the cohort's median report scores occurred over the 18 months, but several institutional policies were examined and altered, and interest and support for a palliative care consultation service was obtained.