A case-controlled study of relatives’ complaints concerning patients who died in hospital: the role of treatment escalation / limitation planning

Taylor, D. R., Bouttell, J. , Campbell, J. N. and Lightbody, C. J. (2020) A case-controlled study of relatives’ complaints concerning patients who died in hospital: the role of treatment escalation / limitation planning. International Journal for Quality in Health Care, 32(3), pp. 212-218. (doi: 10.1093/intqhc/mzaa008) (PMID:32186717)

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Abstract

Objectives To independently assess quality of care among patients who died in hospital and whose next-of-kin submitted a letter of complaint and make comparisons with matched controls. To identify whether use of a treatment escalation limitation plan (TELP) during the terminal illness was a relevant background factor. Design The study was an investigator-blinded retrospective case-note review of 42 complaints cases and 72 controls matched for age, sex, ward location and time of death. Setting The acute medical and surgical wards of three District General Hospitals administered by NHS Lanarkshire, Scotland. Participants None. Intervention None. Outcome measures Quality of care: Clinical ‘problems’, non-beneficial interventions (NBIs) and harms were evaluated using the Structured Judgment Review Method. Complaints were categorized using the Healthcare Complaints Analysis Tool. Results The event frequencies and rate ratios for clinical ‘problems’, NBIs and harms were consistently higher in complaint cases compared to controls. The difference was only significant for NBIs (P = 0.05). TELPs were used less frequently in complaint cases compared to controls (23.8 versus 47.2%, P = 0.013). The relationship between TELP use and the three key clinical outcomes was nonsignificant. Conclusions Care delivered to patients at end-of-life whose next-of-kin submitted a complaint was poorer overall than among control patients when assessed independently by blinded reviewers. Regular use of a TELP in acute clinical settings has the potential to influence complaints relating to end-of-life care, but this requires further prospective study.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Bouttell, Mrs Janet
Authors: Taylor, D. R., Bouttell, J., Campbell, J. N., and Lightbody, C. J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Health Economics and Health Technology Assessment
Journal Name:International Journal for Quality in Health Care
Publisher:Oxford University Press
ISSN:1353-4505
ISSN (Online):1464-3677
Published Online:18 March 2020
Copyright Holders:Copyright © The Author(s) 2020
First Published:First published in International Journal for Quality in Health Care32(3):212–218
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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