Palliative Care Patients in the Emergency Department

Abstract

Although end-of-life care is not a primary function of the emergency department (ED), in reality, many access this department in the later stages of illness. In this study, ED use by patients registered with the Capital Health Integrated Palliative Care Service (CHIPCS) is examined and CHIPCS patient characteristics associated with ED use identified. Overall, 27% of patients made at least one ED visit while registered with CHIPCS; 54% of these resulted in a hospital admission. ED visiting was not associated with time of day or day of the week. Multivariate logistic regression results suggest older patients were significantly less likely to make an ED visit. Making an ED visit was associated with hospital death, rural residence (particularly for women), and having a parent or relative other than a spouse or child as the primary caregiver. Further research may suggest strategies to reduce unnecessary ED visits during the end of life.

Predictors of emergency room visits or acute hospital admissions prior to death among hospice palliative care clients in Ontario: a retrospective cohort study

“…Therefore without the physicians’ confirmation clients might otherwise wait. A previous study reported a similar finding [11]. In addition, clients with at least one ERVH had a longer survival time compared to clients without any ERVH.…”

“…Over half of these visits resulted in hospital admissions. The primary reasons for emergency room visits included pain and shortness of breath [11]. Similar reasons for emergency room visits have been documented in other countries [12-14].…”

“…Because there is variability in length of follow up among studies and there were 22 clients directly admitted to hospital, direct comparisons of emergency room use in this group of clients with that reported in literature may not always be appropriate. Other researchers have reported rates of emergency room use of 6.0% [12], 17.0% [13], 26.6% [11], and 35% [15] among palliative clients. However, those studies had varied observation periods before death (i.e., 1 year, 6 months, 3 months, 1 month).…”

Emergency Nurses' Suggestions for Improving End-of-Life Care Obstacles

“…1 Many patients seeking ED care have advanced chronic illness that requires immediate aid for symptom distress, are experiencing acute change in their health status, or are brought to the emergency department by their caregivers who can no longer physically care for or psychologically cope with these sick family members. 4 As in many other critical care areas of the hospitals, heroic measures often are expected in the emergency department. Patient care plans that include only comfort measures or withholding and even withdrawing medical treatments are viewed as traumatic decisions for most ED clinicians and require an enormous amount of effort to implement.…”

How common are palliative care needs among older people who die in the emergency department?

“…This resonates with the UK government End of Life Care Strategy emphasis on improved recognition of an approaching death and advance care planning, with a view to increasing choice, particularly around the place of death 9. Palliative care assessment and interventions targeting ED users may facilitate achievement of this goal, as the ED will rarely be a preferred place of death 10 11. One palliative care service in Nova Scotia, Canada, which implemented an integrated ‘shared care’ model of palliative care, crossing all places of care (ie, hospital, community and hospice) reported a 7% reduction in the number of patients with cancer presenting to EDs in the year after the service started 12.…”