Leveraging Emergency Department Information Systems to Address Palliative Care Needs of ED Patients During the COVID Pandemic

Tan, Audrey; Swartz, Jordan; Wilkins, Christine; Grudzen, Corita

doi:10.1177/10499091211042854

Cited by 3 publications

(1 citation statement)

References 10 publications

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“…Additionally, this study aimed to recruit a similar population in phase one and phase two; however, the profile and palliative care needs of people presenting to ED changed dramatically in phase two with the onset of the COVID-19 pandemic. Similar trends have been previously reported [ 46 ].…”

Section: Discussionsupporting

confidence: 92%

Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the integrated palliative care outcome scale

Johnston,

Miller,

Normand

et al. 2024

BMC Palliat Care

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Background Older people account heavily for palliative care needs at the population level and are growing in number as the population ages. There is relatively little high-quality data on symptom burden and quality of life, since these data are not routinely collected, and this group are under-recruited in primary research. It is unclear which measurement tools are best suited to capture burdens and experience. Methods We recruited a cohort of 221 patients aged 75 + years with poor prognosis who had an unplanned admission via the emergency department in a large urban hospital in England between 2019 and 2020. Risk of dying was assessed using the CriSTAL tool. We collected primary data and combined these with routine health records. Baseline clinical data and patient reported quality of life outcomes were collected on admission and reassessed within the first 72 h of presentation using two established tools: EQ-5D-5 L, EQ-VAS and the Integrated Palliative Outcomes Scale (IPOS). Results Completion rate was 68% (n = 151) and 33.1% were known to have died during admission or within 6 months post-discharge. The vast majority (84.8%) reported severe difficulties with at least one dimension of EQ-5D-5 L at baseline and improvements in EQ-VAS observed at reassessment in 51.7%. The baseline IPOS revealed 78.2% of patients rating seven or more items as moderate, severe or overwhelming, but a significant reduction (-3.6, p < 0.001) in overall physical symptom severity and prevalence was also apparent. No significant differences were noted in emotional symptoms or changes in communication/practical issues. IPOS total score at follow up was positively associated with age, having comorbidities (Charlson index score > = 1) and negatively associated with baseline IPOS and CriSTAL scores. Conclusion Older people with poor prognosis admitted to hospital have very high symptom burden compared to population norms, though some improvement following assessment was observed on all measures. These data provide valuable descriptive information on quality of life among a priority population in practice and policy and can be used in future research to identify suitable interventions and model their effects.

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Section: Discussionsupporting

confidence: 92%

Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the integrated palliative care outcome scale

Johnston,

Miller,

Normand

et al. 2024

BMC Palliat Care

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show abstract

Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the Integrated Palliative Care Outcome Scale

Johnston,

Miller,

Normand

et al. 2023

Preprint

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Background Older people account heavily for palliative care needs at the population level and are growing in number as the population ages. There is relatively little high-quality data on symptom burden and quality of life, since these data are not routinely collected, and this group are under-recruited in primary research. It is unclear which measurement tools are best suited to capture burdens and experience. Methods We recruited a cohort of 221 patients aged 75 + years with poor prognosis who had an unplanned admission via the emergency department in a large urban hospital in England in 2019 and early 2020. Risk of dying was assessed using the CriSTAL tool. We collected primary data and combined these with routine health records. Baseline clinical data and patient reported quality of life outcomes were collected on admission and reassessed within the first 72 hours of presentation using EQ-5D-5L, EQ-VAS and the Integrated Palliative Outcomes Scale (IPOS). Results Completion rate was 68% (n = 151) and 33.1% were known to have died during admission or within 6 months post-discharge. The vast majority (84.8%) reported severe difficulties with at least one dimension of EQ-5D-5L at baseline and improvements in EQ-VAS observed at reassessment in 51.7%. The baseline IPOS revealed 78.2% of patients rating seven or more items as moderate, severe or overwhelming, but a significant reduction (-3.6, p < 0.001) in overall physical symptom severity and prevalence was also apparent. No significant differences were noted in emotional symptoms or changes in communication/practical issues. IPOS total score at follow up was positively associated with age, having comorbidities (Charlson index score > = 1) and negatively associated with baseline IPOS and CriSTAL scores. Conclusion Older people with poor prognosis admitted to hospital have very high symptom burden compared to population norms, though some improvement following assessment was observed on all measures. These data provide valuable descriptive information on quality of life among a priority population in practice and policy and can be used in future research to identify suitable interventions and model their effects.

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Diretivas Antecipadas de Vontade em pacientes sob Cuidados Paliativos no contexto da COVID-19: uma revisão integrativa

Cestari,

Garces,

Araújo

et al. 2023

Gest. Cuid. Saúde

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Esta pesquisa tem por objetivo aAnalisar as evidências científicas sobre utilização das Diretivas Antecipadas de Vontade em pacientes sob Cuidados Paliativos no contexto da COVID-19. Foi realizada uma revisão integrativa da literatura nas bases de dados SciELO, LILCAS, MEDLINE, PubMed, Scopus e Web of Science, resultando em 22 artigos, caracterizados quanto ao nível de evidência e principais achados. As diretivas antecipadas de vontade orientam o cuidado e reduzem a possibilidade de tratamentos iatrogênicos e contra a vontade, preservando o direito à autonomia e preferências dos sujeitos envolvidos no processo, especialmente no contexto pandêmico atual. A pandemia de COVID-19 fomenta dilemas éticos e legais, reforçando a demanda por diretivas antecipadas de vontade e a importância do debate sobre o tema.

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Leveraging Emergency Department Information Systems to Address Palliative Care Needs of ED Patients During the COVID Pandemic

Cited by 3 publications

References 10 publications

Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the integrated palliative care outcome scale

Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the integrated palliative care outcome scale

Primary data on symptom burden and quality of life among elderly patients at risk of dying during unplanned admissions to an NHS hospital: a cohort study using EuroQoL and the Integrated Palliative Care Outcome Scale

Diretivas Antecipadas de Vontade em pacientes sob Cuidados Paliativos no contexto da COVID-19: uma revisão integrativa

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