Palliative medicine in the emergency department : symptom control and aggressive care
© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:13 |
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| Enthalten in: |
BMJ supportive & palliative care - 13(2023), e2 vom: 07. Dez., Seite e476-e483 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
de Oliveira, Raquel [VerfasserIn] |
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| Links: |
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| Themen: |
Clinical assessment |
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| Anmerkungen: |
Date Completed 16.12.2023 Date Revised 16.12.2023 published: Electronic Citation Status MEDLINE |
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| doi: |
10.1136/bmjspcare-2021-003332 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Palliative medicine in the emergency department |b symptom control and aggressive care |
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a clinical assessment | |
| 650 | 4 | |a end of life care | |
| 650 | 4 | |a hospital care | |
| 650 | 4 | |a pain | |
| 650 | 4 | |a symptoms and symptom management | |
| 650 | 4 | |a terminal care | |
| 700 | 1 | |a Lobato, Carolina B |e verfasserin |4 aut | |
| 700 | 1 | |a Maia-Moço, Leonardo |e verfasserin |4 aut | |
| 700 | 1 | |a Santos, Mariana |e verfasserin |4 aut | |
| 700 | 1 | |a Neves, Sara |e verfasserin |4 aut | |
| 700 | 1 | |a Matos, Maria Francisca |e verfasserin |4 aut | |
| 700 | 1 | |a Cardoso, Rosa |e verfasserin |4 aut | |
| 700 | 1 | |a Cruz, Carla |e verfasserin |4 aut | |
| 700 | 1 | |a Silva, Cátia Araújo |e verfasserin |4 aut | |
| 700 | 1 | |a Dias, Joana |e verfasserin |4 aut | |
| 700 | 1 | |a Maçães, André |e verfasserin |4 aut | |
| 700 | 1 | |a Almeida, Soraia |e verfasserin |4 aut | |
| 700 | 1 | |a Gonçalves, António Pedro |e verfasserin |4 aut | |
| 700 | 1 | |a Gomes, Barbara |e verfasserin |4 aut | |
| 700 | 1 | |a Freire, Elga |e verfasserin |4 aut | |
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