Background Emergency departments (E.D.) are described as suboptimal places to die due to their busy and often crowded nature, lack of time, space or privacy and focus on rapid assessment and recovery (Cooper, Hutchinson, Sheikh, et al. Palliat Med. 2018:32(9):1443–1454; Krebs, Hill, Kirkland, et al. Int Emerg Nurs. 2023;69:101294). E.D. staff report varying skills and confidence to deliver palliative care (Heufel, Kourouche, Wing Shan, et al. Int Emerg Nurs. 2022; 61:101153). Despite the challenges, dying patients present in E.D. for numerous reasons including; life-threatening acute emergencies, crises during terminal illness, uncontrolled symptoms, lack of community services and lack of advance care planning (Cooper, et al.; Krebs, et al.; Heufel, et al.).

Aims We aimed to develop an efficient, safe pathway to enable direct transfer of dying patients from two large emergency departments within our local acute NHS trust to the hospice in-patient unit.

Methods

• Formation of steering group including hospice staff, hospital palliative care team, Consultant in Emergency Medicine.

• Eligibility criteria agreed ensuring safe transfer of appropriate patients.

• Transfer process agreed by steering group and palliative medicine consultants across city.

• Pathway flowchart and telephone triage form developed and agreed by all parties.

• Documents shared electronically with all partners.

• Teaching delivered within E.D. and hospices.

Results Since 2022, 32 patients have been transferred directly from ED to the hospice in-patient unit. Of these patients;

• 12 were already known to the hospice service, 20 had no previous referral.

• Cancer/non cancer split = 50/50%.

• 13 patients transferred in hours (Mon–Fri 09:00–17:00), 19 patients transferred out of hours.

15 patients died within 24 hours of transfer. Seven died within three days of transfer. Five died within a week. Five were discharged after assessment and symptom management.

11 patients were referred but not transferred:

• •  8 no available hospice bed.

• •  2 patients chose admission to hospital.

• •  1 too unstable to move.

Conclusion Collaborative working and innovative thinking enables timely transfer of dying patients from E.D. to a peaceful hospice environment conducive to dignified, expert end of life care.