133 Palliative care in the emergency department – a scoping review

Abstract

Aims/Objectives/Background The World Health Organisation (WHO) estimate that 40 million people a year globally require palliative care, and this need is expanding. The needs of palliative patients are not optimally met in the Emergency Department (ED), in part due to crowding and exit-block. This is further compounded in an ageing population with increasingly complex chronic diseases. Palliative care in the ED is one of the top five research priorities from the Royal College of Emergency Medicine and is often an underestimated part of the ED workload. These patients need to be recognised early and their care considered holistically. This project aims to define the scale of palliative care demand on EDs, describe the care these patients receive, and consider whether we provide truly palliative care for these patients. Methods/Design Data were collected from electronic and written ED records for all patients meeting the inclusion criteria who attended over a 14-day period. Patient records were identified by manually reviewing all electronic records and identifying coding that corresponded to the WHO list of palliative conditions. Demographic, attendance and clinical data were anonymised and analysed descriptively. Results/Conclusions Over the study period, 5% (208/4126) of all ED attendances presented with palliative conditions. This figure is likely to be an underestimate, as electronic systems in this department are not linked to e-notes and written records accompany the patient’s hospital journey. Average time in department was 461 minutes (IQR 274.5 – 621.5). 77% (93/121) of these patients were admitted to hospital, with 96% of those admitted to the Medical Assessment Unit. Only 7% (8/121) left the department with a completed Treatment Escalation Plan (2 of these were pre-existing). This scoping data shows that a small but significant proportion of ED patients have incurable conditions and it may be worth targeting quality, not quantity, of life.