Outcome of Severe Stroke Palliative Care Patients in a Super Tertiary Care Hospital
Keywords:
stroke, palliative care, outcomes of careAbstract
Background and objectives: Stroke is the second top cause of death in the world. According to 2021 Thailand National Health Security Office data, death rate of all stroke patients during admission is 10.58% and 30 days mortality rate after hospital discharge is 16.63%. Severe stroke patients include very poor prognosis, ventilator dependent and severe disabilities are require palliative care (PC). The authors aimed to study the outcome of severe stroke palliative care in a super tertiary care hospital.
Methods: The retrospective medical record review of severe stroke palliative patients which treated under Karunruk Palliative Care Center, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, between 1 January 2018 and 30 September 2020 (3 Years) was conducted under the Donabedian conceptual framework for quality development. The authors focused on 5 issues included advance care plan (ACP), care decisions, mode of death, complications after discharge and hospital readmission rate. Descriptive data were analyzed with SPSS version 28.0.1.0 and presented with frequency and percentage
Results: A total of 57 palliative stroke patients, all patients had ACP (100%) from family and palliative care provider’s discussion. Around 3 quarters of patients (77.19%) received intubation and ventilator support and 22.81 % had no ventilator support. After PC consultation, all the non-ventilated patient’s families agreed with a full palliative care plan. For ventilated patients, 65.91% were required to withdraw life support (WDLS) (16 patients at home and 13 patients in hospital), 31.82% were required to withhold life support and 2.27% family requested full treatment. Most of the patients (93.10%) died after WDLS, 72.41% died within 1 day and all deceases were dead peacefully. From 34 WDLS at home, 20.59% developed complications (pneumonia, urinary tract infection and bedsore) and 8.82% had hospital readmission.
Conclusion: Palliative outcomes of severe stroke patients were satisfied. By the way, the rate of complication and readmission needed to improve. This research is fundamental for further severe stroke palliative program development. Especially in the group who receiving life support treatment and decided to WDLS to allow the patient to die peacefully at home and according to the wishes of the patient and family.
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