Comfort care, also known as hospice care, is medical care designed to reduce a patient’s suffering during a terminal illness. After a patient has a severe stroke, there is no specific protocol for when they should be moved from the hospital to comfort or hospice care. A recent study has found that hospitals differ greatly from one another in how often they move new stroke patients into hospice. The researchers found that doctors are more likely to suggest the transition to hospice earlier if the patient they are treating is an older Caucasian female and uninsured.
Doctor Shyam Prabhakaran, Professor of Neurology and Medical Social Sciences at Northwestern University in Chicago, discovered that the timing of transition was dependent on the type of stroke the patient suffered, as well as the characteristics of the hospital itself. He indicated that further research is needed to identify exactly how hospitals determine these decisions.
According to the lead author of the study, palliative care plays an important role in stroke treatment because the fatality rate is high and there has been little data collected on the transition from treatment to hospice care.
Researchers from Northwestern looked at data collected from over one million patients treated for stroke, provided by 1,675 hospitals over a four-year period. Over 50,000 of these patients were specifically ordered to be transitioned to comfort care treatment only. When the data from all the hospitals were averaged together, only five percent of these patients were moved to comfort care.
The divergence in data when comparing different hospitals was shocking, as some hospitals transferred less than one percent of stroke patients to hospice (0.6 percent), while others transferred 37.6 percent.
Surprising Trends in Study Findings
Overall, patients who suffered bleeding strokes were more likely to be moved to comfort care early, compared to patients whose strokes were caused by a blockage of blood flow to their brains. Patients with bleeding strokes are more likely to suffer fatalities because of their condition.
Not only were older Caucasian female patients transferred to hospice earlier, but those who were unable to walk, uninsured, or covered by Medicaid were also more likely to have early comfort orders. Interestingly, patients who arrived at the hospital by ambulance or during off-hours were more likely to transition early on as well.
Others in the medical field have noted that severe strokes cause much grief and concern in families, prompting a series of conversations between doctors, patients, and their families. These discussions center on what kind of treatment is acceptable and what is not. It may be that the input of the stroke-sufferers and their loved ones are what is driving this data, not the response of a specific hospital.
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