• C Y Lin, R M Arnold, J R Lave, D C Angus, and A E Barnato.
• Center for Research on Health Care and the Institute for Clinical Research Education, University of Pittsburgh School of Medicine, 200 Meyran Avenue, Suite 200, Pittsburgh, PA 15213, USA.
• Qual Saf Health Care. 2010 Dec 1;19(6):e12.

BackgroundImproving end-of-life care in the hospital is a national priority.PurposeTo explore the prevalence and reasons for implementation of hospital-wide and intensive care unit (ICU) practices relevant to quality care in key end-of-life care domains and to discern major structural determinants of practice implementation.DesignCross-sectional mixed-mode survey of chief nursing officers of Pennsylvania acute care hospitals.ResultsThe response rate was 74% (129 of 174). The prevalence of hospital and ICU practices ranged from 95% for a hospital-wide formal code policy to 6% for regularly scheduled family meetings with an attending physician in the ICU. Most practices had less than 50% implementation; most were implemented primarily for quality improvement or to keep up with the standard of care. In a multivariable model including hospital structural characteristics, only hospital size independently predicted the presence of one or more hospital initiatives (ethics consult service, OR 6.13, adjusted p = 0.02; private conference room in the ICU for family meetings, OR 4.54, adjusted p<0.001).ConclusionsThere is low penetration of hospital practices relevant to quality end-of-life care in Pennsylvania acute care hospitals. Our results may serve to inform the development of future benchmark goals. It is critical to establish a strong evidence base for the practices most associated with improved end-of-life care outcomes and to develop quality measures for end-of-life care to complement existing hospital quality measures that primarily focus on life extension.

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