Background It is becoming increasingly recognised among healthcare professionals that for patients approaching the end of life, a busy Emergency Department (ED) or acute hospital ward is an unsuitable environment to meet their needs.
Methods A retrospective data analysis of patients (n=131) with a known palliative diagnosis who were admitted to hospital via the ED in January 2018. Data was gathered through use of online patient records and hospital notes.
Results In January 2018, 3% of all admissions via the ED were patients with known palliative diagnoses. On arrival in the ED, less than 1 in 4 were known to the community palliative care team, and 35% had a DNACPR form. 67% attended outside normal working hours. For 83% it was felt that ED attendance could have been avoided if more community support had been in place or if an appropriate service had been contacted.
More than half (60%) of patients died in hospital this admission. Of the 53 patients who survived this admission and were discharged; 83% had a DNACPR form in place, 40% had an Emergency Healthcare Plan, and 38% of those not known to the community palliative care team were referred on discharge.
The majority (84%) of patients with an existing palliative diagnosis who were admitted via the ED did so in the last 100 days of life.
Conclusions This study highlights the importance of implementing advance care planning both in and out of hospital, and prioritising time with patients to discuss values, anxieties, anticipated emergencies, resuscitation and death. This would not only reduce futile treatments and deaths in hospital for palliative patients, but ensure that their preferences are respected and their needs are appropriately met when they are at their most vulnerable.
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