A Literature Review on Care at the End-of-Life in the Emergency Department

Abstract

<jats:p>The hospitalisation and management of patients at the end-of-life by emergency medical services is presenting a challenge to our society as the majority of people approaching death explicitly state that they want to die at home and the transition from acute care to palliation is difficult. In addition, the escalating costs of providing care at the end-of-life in acute hospitals are unsustainable. Hospitals in general and emergency departments in particular cannot always provide the best care for patients approaching end-of-life. The main objectives of this paper are to review the existing literature in order to assess the evidence for managing patients dying in the emergency department, and to identify areas of improvement such as supporting different models of care and evaluating those models with health services research. The paper identified six main areas where there is lack of research and/or suboptimal policy implementation. These include uncertainty of treatment in the emergency department; quality of life issues, costs, ethical and social issues, interaction between ED and other health services, and strategies for out of hospital care. The paper concludes with some areas for policy development and future research.</jats:p>

Dilema Etik dalam Merawat Pasien Terlantar yang Menjelang Ajal di IGD

“…Jumlah kunjungan pasien yang banyak dan berbagai macam keluhan dengan perbedaan tingkat kegawatan pasien. Kondisi ruangan IGD yang padat dan tidak terprediksi seringkali menjadikan sumber daya yang ada terbenam dalam kepadatan pasien yang masuk (Christ, Grossmann, Winter, Bingisser, & Platz, 2010). Faktor lingkungan perawat memegang peranan penting dalam hubungan antara perawat dan pasien.…”

“…Dilema etik sering dialami oleh perawat IGD dalam merawat pasien terlantar dalam fase menjelang ajal yang tidak memiliki identitas. Berdasarkan hasil laporan tahunan RSSA Malang (2014) (Forero et al, 2012). End Of life care bertujuan agar pasien merasa bebas dari rasa nyeri, nyaman, dihargai, dihormati dan berada dalam kedamaian dan ketenangan serta merasa dekat dengan orang merawatnya (Aligood & Tomey, 2014).…”

Promoting dignified end-of-life care in the emergency department: A qualitative study

“…The respect towards the dignity of human life is also extended to the process of death, modifying the clinical relationship [2]. The hospitalization of a dying person in the Emergency Department (ED) has implications for maintaining his/her dignity, which can be a challenge for healthcare professionals [3,4]. In light of technological developments, the ED focuses on healing and maintaining life but this care framework is changing with regard to the dying patient [5].…”

“…In other studies, physicians and nurses in the ED have expressed the need for specialized training (Pretorius et al, 2015) [10,26,31] for example, to know when to move on from a healing treatment to palliative care [3], how to effectively implement physician orders for life-sustaining treatment [26] or how to relieve pain and distress by administering opioids and other medication (e.g. IV paracetamol, anti-emetics, muscle relaxants etc.)…”

Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta

“…Forero et al, (2012) reviewed the existing literature on patients dying in the A&E and identified six areas where there is little research and/or suboptimal policy implementation (A&E treatment uncertainty; quality of life issues, costs, ethical and social issues, interaction between A&E and other health services, and strategies for non-hospital care). Forero et al, (2012) recommend a structured approach to decision making and a proper infrastructure, information and forwardplanning strategy, prompting the need for further research. Although this review focuses on end-of-life patients, the same recommendations may be applied across the entire A&E patient management spectrum.…”