Background Patients with end-stage illness who may be at the end of life often attend the Emergency Department (ED). Such patients have specific needs, which can present challenges in the ED environment.^1–3 Close working between the ED team and Specialist Palliative Care Team (SPCT) can help address barriers to care for this patient cohort⁴ while providing opportunities for early identification of such patients.

Methods A quality improvement project using ‘Plan, Do, Study, Act’ (PDSA) methodology was undertaken by the ED and SPCT teams in a mid-sized district general hospital in England. The primary aim was to identify patients with palliative care needs earlier in their journey under a parallel planning approach. A run chart of the percentage of total monthly referrals to SPCT received from ED was used as the primary outcome. Questionnaires were also used to collect information for secondary outcomes exploring ED team experiences with palliative care. A first PDSA cycle involved SPCT attending the morning ED medical handover. This enabled informal advice and facilitated direct referrals. A second cycle delivered a month-long, multimodal, multidisciplinary education program on palliative care in the ED.

Results The percentage of monthly SPCT referrals from ED increased from 3% to 18% with joint handover. After the education program, the percentage of the ED team familiar with the concept of parallel planning increased from 53% to 71%. This change was sustained at 3 months after teaching.

Conclusion Joint handover and multidisciplinary education helped improve collaboration between SPCT and ED teams. This may be achieved in other centres using a similar model. Future PDSA cycles will focus on consolidating learnings through further education, developing clinical tools to further support the ED team, and exploring impact of changes on patients.

References

1. Royal College of Emergency Medicine. The RCEM End of Life Care Toolkit, 2020. Available here: https://rcem.ac.uk/wp-content/uploads/2021/10/RCEM_End_of_Life_Care_Toolkit_December_2020_v2.pdf

2. Savory EA, Marco CA. End-of-life issues in the acute and critically ill patient. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2009 Dec;17:1–0.

3. Deasy C. Attitudes and knowledge of emergency doctors towards end-of-life care in the emergency department: a national survey. European Journal of Emergency Medicine. 2023 Aug 1;30(4):267–70.

4. Gips A, Daubman BR, Petrillo LA, Bowman J, Ouchi K, Traeger L, Jackson V, Grudzen C, Ritchie CS, Aaronson EL. Palliative care in the emergency department: A qualitative study exploring barriers, facilitators, desired clinician qualities, and future directions. Palliative & Supportive Care. 2022 Jun;20(3):363–8.