Critical Care Documentation for the Dying Trauma Patient: Are We Recognizing Our Own Efforts?

Abstract

Background Missed documentation for critical care time (CCT) for dying patients may represent a missed opportunity for physicians to account for intensive care unit (ICU) services, including end-of-life care. We hypothesized that CCT would be poorly documented for dying trauma patients. Methods Adult trauma ICU patients who died between December 2014 and December 2017 were analyzed retrospectively. Critical care time was not calculated for patients with comfort care code status. Critical care time on the day prior to death and day of death was collected. Logistic regression was used to determine factors associated with documented CCT. Results Of 147 patients, 43% had no CCT on day prior to death and 55% had no CCT on day of death. 82% had a family meeting within 1 day of death. Family meetings were independently associated with documented CCT (OR 3.69, P = .008); palliative care consultation was associated with decreased documented CCT (OR .24, P < .001). Conclusions Critical care time is not documented in half of eligible trauma patients who are near death. Conscious (time spent in family meetings and injury acuity) and unconscious factors (anticipated poor outcomes) likely affect documentation.

Clinical Study of Influence of Continuous Nursing Intervention Combined with Comfort Nursing Intervention under Medical-Nursing Combination on Self-Care Ability and Satisfaction of Elderly Patients with Chronic Diseases

“…Continuous nursing combined with comfort nursing based on the medical-nursing combination was conducted to patients in the experimental group. During comfort nursing, nursing personnel paid close attention to patients' emotional changes, comfort, and satisfaction, so as to enable them to feel physical and mental pleasure as far as possible [8,10,11].…”