Palliative care interventions for adults in the emergency department: A review of components, delivery models, and outcomes

Abstract

Background Existing evidence suggest the emergence of palliative care (PC) services in the emergency department (ED). To gain insight into the nature of these services and provide direction to future actions, there is a need for a comprehensive review that ascertains the components of these services, integration models, and outcomes. Methods A scoping review design was employed and reported according to the PRISMA extension guidelines for scoping reviews. Extensive searches in peer‐reviewed databases (CINAHL, EMBASE, PubMed, Cochrane Library, and Medline) and gray literature sources (Trove, MedNar, OpenGrey, and the Agency for Healthcare Research and Quality) were undertaken and supplemented with hand searching. Titles, abstracts, and full text were reviewed in duplicate. Studies were eligible for inclusion if they reported on a PC intervention implemented in the ED for adults. Codes were formulated across the included studies, which facilitated the conduct of a narrative synthesis. Results Twenty‐three studies were retained with the majority (n = 15) emerging from the United States. The components of PC interventions in the ED were categorized as: (1) screening, (2) goals of care discussion and communication, (3) managing pain and other distressing symptoms in the ED, (4) transitions across care settings, (5) end‐of‐life (EoL) care, (6) family/caregiver support, and (7) ED staff education. Traditional PC consultations and integrated ED–PC services were the main modes of delivery. PC in the ED can potentially improve patient symptoms, facilitate access to relevant services, reduce length of stay, improve care at the EoL, facilitate bereavement and postbereavement support for family members, and improve ED staff confidence in delivering PC. Conclusions PC implementation in the ED may potentially improve patient and family outcomes. More studies are needed, however, to standardize trigger or screening tools. More prospective studies are also needed to test PC interventions in the ED.

Healthcare professionals’ perspectives of the management of people with palliative care needs in the Emergency Department of a UK hospital

“…It was felt that, provided they have the appropriate equipment and drugs, doctors in the ED can effectively manage the symptoms palliative and EOL patients present with, such as pain and a deterioration in a patient's medical condition. This was in contrast to the ndings from a qualitative study by Bayuo et al in which data were also collected using in-depth interviews with emergency department staff (27). Participants experienced feelings of failure and helplessness when treating patients requiring EOL care.…”

Impact of First Wave of COVID-19 Pandemic on Mortality at Emergency Department in Older Patients with COVID and Non-COVID Diagnoses

“…Many of them arrived with previous conditions of great comorbidity and dependency. EDs must identify patients for whom end-of-life care is necessary or preferred and be equipped to deliver this care excellently [5,34], even if it is not the most appropriate level of that care [6].…”

Do Perceptions about Palliative Care Affect Emergency Decisions of Health Personnel for Patients with Advanced Dementia?

“…Although benefits and acceptance of PC have evolved over the last decades, in certain societies and under specific medical settings, such as in departments of emergency medicine, its implementation is limited [ 65 ]. Varied tools that screen for the presence of PC needs were employed and adjusted for emergency care [ 66 ].…”