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Hospital Staff Training Improves Palliative Care Processes

In-hospital intervention leads to improvements in quality end points for end-of-life care

MONDAY, Feb. 3, 2014 (HealthDay News) -- A hospital staff education intervention can improve several processes of palliative care in the inpatient setting, according to a study published online Jan. 21 in the Journal of General Internal Medicine.

F. Amos Bailey, M.D., from the Birmingham/Atlanta Geriatric Research, Education, and Clinical Center in Alabama, and colleagues evaluated the effectiveness of a multimodal intervention strategy to improve processes of end-of-life care in inpatient settings at six Veterans Affairs Medical Centers. The intervention consisted of staff training for all hospital providers to identify actively dying patients and implement best practices from home-based hospice care. Quality end points for end-of-life care (last seven days) were extracted from the electronic medical records of 6,066 veterans who died before or after the intervention.

The researchers observed significant intervention effects for orders of opioid pain medication, antipsychotic medications, benzodiazepines, and scopolamine for death rattle (odds ratios [ORs], 1.39, 1.98, 1.39, and 2.77, respectively). There were also significant intervention effects seen for sublingual administration (OR, 4.12), nasogastric tubes (OR, 0.71), and advance directives (OR, 1.47). Location of death, do-not-resuscitate orders, intravenous lines, and restraints were not significantly affected by the intervention.

"This broadly-targeted intervention strategy led to modest but statistically significant changes in several processes of care, indicating its potential for widespread dissemination to improve end-of-life care for thousands of patients who die each year in inpatient settings," the authors write.

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