I love my food, and some (mainly my wife, staff members, and the World Health Organisation) would say I love my food too much. So when I hear about crimes committed against food it really annoys me. Hospital food usually has a bad reputation. Mass produced food in general is usually not as good. The recent trend in New Zealand hospitals is for food to be manufactured in a central location and then for all the food to be transported to all of the hospitals. Though this may make economic sense, it is makes no gastronomic sense at all.
This goes against treatment of patients as human beings. Patients are served unappealing material that may have had a natural origin at some point in its life time. It takes a lot of skill to transform random bits of plants and animals into things that resemble plastic in the way it looks and tastes. Patients are in hospitals because they are unwell, and it does no-one any favours when the food they are served makes them feel even sicker.
A plate of fish and mashed potatoes was an example that my cousin told me about. The fish was dry and rubbery, with all nutritional content having been consigned to the pages of history long ago. The mashed potato had given up its moral integrity. Having once lived in a hole in the ground, the potato had been harshly dragged into the light. Flayed whilst still alive, and then subjected to a death by a thousand cuts. Turned into tiny molecules of potato, smashed into uniform shapes. Then dried out along with billions of similarly shaped friends, and repackaged. Add water to make instant mash potato. Instant it may have become, but potato it was in name only.
Kasia’s research aims to improve sustainable acute care health delivery for an ageing population, while her clinical experience includes general medical and acute palliative care. In her PhD, Kasia developed an approach to measure nurse-sensitive outcomes, which is currently being used to evaluate a Government-funded implementation of a cognitive identifier. Kasia has a passion for identifying and researching the structures and processes which impede or enable quality patient care, and sharing her learning and inquiry with nursing students, industry and professional groups. Here, Palliverse asks her about her latest research project and dipping her toe into the world of social media.
Not the traditional festive season article perhaps, but this review article by Dr Blinderman and the late Dr Billings provides a good summary in a very reputable and widely read journal concerning end of life care in hospitals in the United States.
Is end of life care in hospital in the US different?
The article reports that 29% of deaths take place in hospitals in America, a bit lower than I would have expected. In Australia, 54% die in hospital but this includes inpatient palliative care deaths which are excluded from the US figure of 29%.
According to AIHW, 42% of the Australians who died in hospital had some involvement from palliative care (42% of 54% in hospital deaths is 23%) About a third of patients who died as an admitted patient in hospital (a third of 54% is about 15%) died in inpatient palliative care. That still leaves us behind the US, with around 36% dying in a non palliative inpatient Australian hospital bed compared to 29% in the USA.
Interestingly the NEJM article does not refer to subcutaneous medications which are the mainstay of terminal care medication administration in Australia, New Zealand and the UK. Do US practitioners use less SC medication?
Personally I don’t find that cough and nausea are so troubling at the end of life, and we would promote meticulous mouth care for dry mouth ahead of pharmacological management.
The article also advises us to avoid benzodiazepines for delirium including at the end of life, which I found surprising.
Dear reader, do you have any thoughts? What is end of life care like in hospitals in your neck of the woods?
I have so many links to share with you. Here are a few of them:
Australian critical care doctor and blogger Andy W writes about death and taxes and asks, “…why is it that we seem to spend so much time talking about the taxes, and not nearly enough about death?” Thought-provoking stuff. “The Things That Are Certain“, The Flying PhD