Palliative care in the emergency department: A systematic literature qualitative review and thematic synthesis

Cooper, E; Hutchinson, Ann; Sheikh, Zain; Taylor, Paul; Townend, William; Johnson, Miriam J.

doi:10.1177/0269216318783920

Cited by 52 publications

(85 citation statements)

References 56 publications

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“…However, our findings do align with previously published literature reporting that although most emergency medicine clinicians have had little or no formal training in PC skills they view palliative medicine as valuable in improving the care of patients in the ED, and have interest in more PC integration. 21 , 22 , 23 …”

Section: Discussionmentioning

confidence: 99%

The Experience of Emergency Department Providers With Embedded Palliative Care During COVID

Aaronson

Petrillo

Stoltenberg

et al. 2020

Journal of Pain and Symptom Management

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Introduction Although the importance of palliative care (PC) integration in the Emergency Department (ED) has long been recognized, few formalized programs have been reported and none have evaluated the experience of ED clinicians with embedded PC. We evaluate the experience of ED clinicians with embedded PC in the ED during COVID. Methods ED clinicians completed a survey about their perceptions of embedded PC in the ED. We summarized responses to closed-ended items using descriptive statistics and analyzed open-ended items using thematic analysis. Results There were 134 ED clinicians surveyed. 101 replied (75% response rate). Of those that had interacted with PC, 100% indicated a benefit of having PC involved. These included freeing up ED clinicians for other tasks (89%), helping them feel more supported (84%), changing the patients care trajectory (67%), and contributing to clinician education (57%) and skills (49%). Among barriers related to engaging PC were difficulty locating them (8%) and lack of time to consult due to ED volume (5%). 98% of respondents felt that having PC in the ED was either “valuable” or “very valuable.” Open-ended responses reflected a positive impact on clinician wellness and improvement in access to high quality goal concordant care. Clinicians expressed gratitude for having PC in the ED and noted the importance of having readily available and easily accessible PC in the ED. Conclusion ED clinicians’ perception of embedded PC was overall positive, with an emphasis on the impact related to task management, enrichment of PC skills, providing support for the team, and improved care for ED patients.

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Section: Discussionmentioning

confidence: 99%

The Experience of Emergency Department Providers With Embedded Palliative Care During COVID

Aaronson

Petrillo

Stoltenberg

et al. 2020

Journal of Pain and Symptom Management

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“…The authors share the opinion of several other authors [34, 35, 38] that more training is required for EM physicians and that palliative care should be a component of the EM training curriculum and palliative care should be considered/started whenever a dire clinical outcome is predicted for a patient (see below).…”

Section: Discussionmentioning

confidence: 78%

“…Palliative care has been identified in the literature as an area where EDs fall short of their role and responsibilities towards patients [34, 35]. For the purposes of this study, the authors used the World Health Organisation's definition of palliative care: “ an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness , through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems , physical , psychosocial and spiritual.” The authors further accept that Palliative Care does not automatically assume that the outcome is death, and many patients on palliative care are later taken off as the underlying pathologies improve.…”

Section: Discussionmentioning

confidence: 99%

Death in the Emergency Department: A Retrospective Analysis of Mortality in a Swiss University Hospital

Heymann

Wicky

Carron

et al. 2019

Emergency Medicine International

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Acute treatment in emergency medicine revolves around the management and stabilization of sick patients, followed by a transfer to the relevant medical specialist, be it outpatient or inpatient. However, when patients are too sick to be stabilized, i.e., when the care provided in the Emergency Department (ED) may not be sufficient to enable transfer, death may occur. This aspect of emergency medicine is often overlooked, and very few public data exist regarding who dies in the ED. The following retrospective analysis of the mortality figures of a Swiss university hospital from January 1st 2013 to December 31st 2016 attests to the fact that with an incidence of 2.6/1,000, death does occur in the ED. With a broad range of aetiologies, clinical severity at presentation has a high correlation with mortality, a finding that reinforces the necessity of good triage system. Our analysis goes on to show that however (in)frequent death in the ED may be, there exists a lack of advanced directives in a majority of patients (present in only 14.8% of patients during the time of study), a worrying and often challenging situation for Emergency Medicine (EM) teams faced with premorbid patients. Furthermore, a lack of such directives may hinder access to palliative care, as witnessed in part by the fact that palliative measures were only started in 16.6% of patients during the study. The authors hope this study will serve as a stepping stone to promote further research and discussion into early identification methods for patients at risk of death in the ED, as well as motivate a discussion into the integration of palliative care within the ED and EM training curriculum.

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“…For most patients, admission to the acute care floor or ICU is preceded by a stay in the emergency department, a place in which exploration of goals of care and treatment preferences can be extremely challenging. 52–57 Rapidly changing physiology, scarcity of information about the patient’s premorbid function, and time constraints all affect the ability to align care with goals and preferences in the emergency department. Moreover, patients might be unable to communicate, requiring clinicians to rely on family members to participate in the decision-making.…”

Section: Interventions In the Hospital Settingmentioning

confidence: 99%

Pragmatic methods to avoid intensive care unit admission when it does not align with patient and family goals

Long

Lee

McDermott

et al. 2019

The Lancet Respiratory Medicine

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For patients with chronic, life-limiting illnesses, admission to the intensive care unit (ICU) near the end of life might not improve patient outcomes or be consistent with patient and family values, goals, and preferences. In this context, advance care planning and palliative care interventions designed to clarify patients' values, goals, and preferences have the potential to reduce provision of high-intensity interventions that are unwanted or non-beneficial. In this Series paper, we have assessed interventions that are effective at helping patients with chronic, life-limiting illnesses to avoid an unwanted ICU admission. The evidence found was largely from observational studies, with considerable heterogeneity in populations, methods, and types of interventions. Results from randomised trials of interventions to improve communication about goals of care are scarce, of variable quality, and mixed. Although observational studies show that advance care planning and palliative care interventions are associated with a reduced number of ICU admissions at the end of life, causality has not been well established. Using the available evidence we suggest recommendations to help to avoid ICU admission when it does not align with patient and family values, goals, and preferences and conclude with future directions for research.

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Palliative care in the emergency department: A systematic literature qualitative review and thematic synthesis

Abstract: Background: Despite a fast-paced environment, the emergency clinician has a duty to meet the

Cited by 52 publications

References 56 publications

The Experience of Emergency Department Providers With Embedded Palliative Care During COVID

The Experience of Emergency Department Providers With Embedded Palliative Care During COVID

Death in the Emergency Department: A Retrospective Analysis of Mortality in a Swiss University Hospital

Pragmatic methods to avoid intensive care unit admission when it does not align with patient and family goals

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