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

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.