RT Journal Article
SR Electronic
T1 Palliative medicine in the emergency department: symptom control and aggressive care
JF BMJ Supportive & Palliative Care
JO BMJ Support Palliat Care
FD British Medical Journal Publishing Group
SP bmjspcare-2021-003332
DO 10.1136/bmjspcare-2021-003332
A1 Raquel de Oliveira
A1 Carolina B. Lobato
A1 Leonardo Maia-Moço
A1 Mariana Santos
A1 Sara Neves
A1 Maria Francisca Matos
A1 Rosa Cardoso
A1 Carla Cruz
A1 Cátia Araújo Silva
A1 Joana Dias
A1 André Maçães
A1 Soraia Almeida
A1 António Pedro Gonçalves
A1 Barbara Gomes
A1 Elga Freire
YR 2021
UL http://spcare.bmj.com/content/early/2021/09/01/bmjspcare-2021-003332.abstract
AB Objectives Identifying the prevalence of palliative care (PC) needs among patients who die at the emergency department (ED) and to assess symptom control and aggressiveness of care.Methods We conducted a decedent cohort study of adults deceased at the ED of a Portuguese teaching hospital in 2016. PC needs were identified using the National Hospice Organization terminality criteria and comorbidities measurement by the Charlson’s Index.Results 384 adults died at the ED (median age 82 (IQR 72–89) years) and 78.4% (95% CI 73.9% to 82.2%) presented PC needs. Only 3.0% (n=9) were referred to the hospital PC team. 64.5%, 38.9% and 57.5% experienced dyspnoea, pain and confusion, respectively. Dyspnoea was commonly medicated (92%), against 56% for pain and 8% for confusion. Only 6.3% of the patients were spared from aggressive interventions, namely blood collection (86.0%) or intravenous fluid therapy (63.5%). The burden of aggressive interventions was similar between those with or without withhold cardiopulmonary resuscitation order (median 3 (2–4) vs 3 (2–5)), p=0.082.Conclusions Nearly four out of five adults who died at the ED had PC needs at the time of admission. Most experienced poor symptom control and care aggressiveness in their last hours of life and were mostly unknown to the PC team. The findings urge improvements in the care provided to patients with PC needs at the ED, focusing on patient well-being and increased PC referral.