Quality of documented consent for the de-escalation of care on a general and trauma surgery service

Joseph Thomasson, Tommy Petros, Shauna Lorenzo-Rivero, Richard A. Moore, John Stanley

Research output: Contribution to journalArticle

Abstract

Postoperative and posttrauma mortality in the acute care setting often occurs after a decision for de-escalation of care. It is important that the quality of consent for de-escalation of care is maintained to ensure patient autonomy. This retrospective review aims to determine the quality of the consent process for care de-escalation in patients on a trauma and general surgery service who sustained in-hospital mortality. One hundred thirty-three patients (99 trauma) were identified who died in 1 year. Of these patient deaths, 80 (60%) involved de-escalation of care. In three (3%) cases, there were no documented discussions for de-escalation consent. Of the remaining cases, documentation was considered optimal 21 per cent of the time. Only nine (11%) patients were able to participate in a discussion of their end-of-life care. The other 23 patients who were initially competent lost their ability to participate in discussions after a debilitating event. In this study, the majority of patients who died on a surgical service underwent a de-escalation of care. The documentation quality was suboptimal in most cases. Earlier and more thorough discussion of the patient's end-of-life wishes may improve the de-escalation of care consent process.

Original languageEnglish (US)
Pages (from-to)883-887
Number of pages5
JournalAmerican Surgeon
Volume77
Issue number7
StatePublished - Jul 1 2011
Externally publishedYes

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Wounds and Injuries
Documentation
Terminal Care
Hospital Mortality
Mortality

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Thomasson, J., Petros, T., Lorenzo-Rivero, S., Moore, R. A., & Stanley, J. (2011). Quality of documented consent for the de-escalation of care on a general and trauma surgery service. American Surgeon, 77(7), 883-887.

Quality of documented consent for the de-escalation of care on a general and trauma surgery service. / Thomasson, Joseph; Petros, Tommy; Lorenzo-Rivero, Shauna; Moore, Richard A.; Stanley, John.

In: American Surgeon, Vol. 77, No. 7, 01.07.2011, p. 883-887.

Research output: Contribution to journalArticle

Thomasson, J, Petros, T, Lorenzo-Rivero, S, Moore, RA & Stanley, J 2011, 'Quality of documented consent for the de-escalation of care on a general and trauma surgery service', American Surgeon, vol. 77, no. 7, pp. 883-887.
Thomasson, Joseph ; Petros, Tommy ; Lorenzo-Rivero, Shauna ; Moore, Richard A. ; Stanley, John. / Quality of documented consent for the de-escalation of care on a general and trauma surgery service. In: American Surgeon. 2011 ; Vol. 77, No. 7. pp. 883-887.
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