Sage Journals: Discover world-class research

Abstract

Background:

Presentations to the emergency department (ED) by patients with end-of-life (EOL) conditions for their acute care needs are common.

Objectives:

The objective of this study was to identify and describe the ED management across presentations to the ED for EOL conditions.

Design:

Prospective observational cohort study.

Settings/Subjects:

Emergency physicians in two Canadian ED's were asked to identify presentations by adult patients with EOL conditions using a modified screening tool.

Measurements:

Patient characteristics and ED management for each presentation were collected through chart review by trained research assistants. Descriptive analyses were conducted as appropriate and bivariate comparisons of dichotomous and continuous variables were completed using χ² tests and using t test or Wilcoxon rank-sum test, respectively.

Results:

Physicians identified 663 ED presentations for EOL conditions, with advanced cancer (41%), dementia (23%), and chronic obstructive pulmonary disease (16%) being the most common EOL conditions. The majority of presentations involved consultations (77%), hospitalization (65%), and numerous investigations (97%), including blood work (97%) and imaging (92%). The majority of patients with EOL conditions had a history of ED visits (68%). Using a modified screening tool, 78% of presentations involved patients with unmet palliative care needs, but only 1% of presentations involved a palliative consultation or admission to a palliative care unit.

Conclusion:

Presentations to the ED for EOL conditions involve significant ED resources; however, only a handful of patients are referred to palliative services. Patients with EOL conditions are appropriate targets for palliative services and community support outside the ED.

Get full access to this article

View all access options for this article.

References

Grudzen

, Richardson

, Morrison

, et al.: Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med, 2010; 17:1253–1257.

Beynon

, Gomes

, Murtagh

, et al.: How common are palliative care needs among older people who die in the emergency department?. Emerg Med J, 2011; 28:491–495.

George

, Phillips

, Zaurova

, et al.: Palliative care screening and assessment in the emergency department: A systematic review. J Pain Symptom Manage, 2016; 51:108–119.

Huang

, Alsaba

, Brookes

, et al.: Review article: End-of-life care for older people in the emergency department: A scoping review. Emerg Med Australas, 2020; 32:7–19.

Verhoef

, de Nijs

, Horeweg

, et al.: Palliative care needs of advanced cancer patients in the emergency department at the end of life: An observational cohort study. Support Care Cancer, 2020; 28:1097–1107.

Verhoef

, de Nijs

EJM

, Fiocco

, et al.: Surprise question and performance status indicate urgency of palliative care needs in patients with advanced cancer at the emergency department: An observational cohort study. J Palliat Med, 2020; 23:801–808.

Schulman

, Zalenski

, Johnson

: Palliative care screening in the emergency department. Acad Emerg Med, 2015; 22:S283–S284.

Bond

, Strout

, Haydar

, et al.: Emergency physician responses to the surprise question and identification of unmet palliative care needs. Acad Emerg Med, 2014; 21:S193.

George

, Barrett

, McPeake

, et al.: Content validation of a novel screening tool to identify emergency department patients with significant palliative care needs. Acad Emerg Med, 2015; 22:823–837.

10.

Ouchi

, Block

, Schonberg

, et al.: Feasibility testing of an emergency department screening tool to identify older adults appropriate for palliative care consultation. J Palliat Med, 2017; 20:69–73.

11.

Harris

, Taylor

, Thielke

, et al.: Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform, 2009; 42:377–381.

12.

Murray

, Bullard

, Grafstein

, et al.: Revisions to the Canadian Emergency Department Triage and Acuity Scale implementation guidelines. CJEM, 2004; 6:421–427.

13.

Bullard

, Musgrave

, Warren

, et al.: Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) guidelines 2016. CJEM, 2017; 19:S18–S27.

14.

Grafstein

, Bullard

, Warren

, et al.: Revision of the Canadian Emergency Department Information System (CEDIS) Presenting Complaint List version 1.1. CJEM, 2008; 10:151–173.

15.

Levy

, Han

, Dayan

, et al.: Emergency department (ED) initiated palliative care (PC) in end of life (EOL) ICU consults. A randomized clinical trial. Intens Care Med Exp, 2017; 5:484.

16.

Weng

, Yang

, Chen

, et al.: Implementing a novel model for hospice and palliative care in the emergency department: An experience from a tertiary medical center in Taiwan. Medicine (Baltimore), 2017; 96:e6943.

17.

Tiernan

, Ryan

, Casey

, et al.: A quasi-experimental evaluation of an intervention to increase palliative medicine referral in the emergency department. J Health Serv Res Policy, 2019; 24:155–163.

18.

Maddison

, Malik

, Smaggus

: Inpatient palliative care consultations from a Canadian Clinical Teaching Unit: Who is referred and when?. J Palliat Care, 2018; 33:204–208.

19.

Weeks

, Catalano

, Cronin

, et al.: Patients' expectations about effects of chemotherapy for advanced cancer. N Engl J Med, 2012; 367:1616–1625.

20.

Karim

, Harle

, O'Donnell

, et al.: Documenting goals of care among patients with advanced cancer: Results of a quality improvement initiative. J Oncol Pract, 2018; 14:e557–e565.

21.

Grudzen

, Hwang

, Cohen

, et al.: Characteristics of emergency department patients who receive a palliative care consultation. J Palliat Med, 2012; 15:396–399.

22.

Ouchi

, Jambaulikar

, George

, et al.: The “surprise question” asked of emergency physicians may predict 12-month mortality among older emergency department patients. J Palliat Med, 2018; 21:236–240.

23.

Reuter

, Marshall

, Zaidi

, et al.: Emergency department-based palliative interventions: A novel approach to palliative care in the emergency department. J Palliat Med, 2019; 22:649–655.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.01 MB

0.02 MB