Palliative care for patients who died in emergency departments: analysis of a multicentre cross-sectional survey

• Published in: Emergency medicine journal : EMJ Vol. 29; no. 10; pp. 795 - 797
• Main Authors: Van Tricht, Myriam, Riochet, David, Batard, Eric, Martinage, Arnaud, Montassier, Emmanuel, Potel, Gilles, Le Conte, Philippe
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine 01.10.2012; BMJ Publishing Group LTD
• Subjects: aged; Analgesics; Belgium; cardiac arrest; Cause of Death; Chi-Square Distribution; clinical management; Cross-Sectional Studies; death; Death & dying; death/mortality; Departments; Emergency medical care; Emergency medicine; Emergency Service, Hospital - statistics & numerical data; ethics; Family medical history; Female; France; Hospice care; Hospital Mortality; Hospitals; Humans; Life Support Care; Logistic Models; Male; Multivariate analysis; Palliative Care; Prospective Studies; Social support; Statistical analysis; Time Factors; Withholding Treatment; Belgium; France
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emermed-2011-200513

ObjectivesA growing number of patients die each year in hospital emergency departments (EDs). Decisions to withhold or to withdraw life-support therapies occur in 80% of patients as described in a multicentre cross-sectional survey including 2420 patients. Palliative care has not been explored in patients dying in this setting. The aim of this study was to assess the incidence of palliative care and to describe this population.MethodsThe authors conducted a post-hoc analysis on a cohort of 2420 patients who died in 174 French and Belgian EDs. The authors identified patients who benefited from palliative care and described this population and the palliative care.ResultsPalliative therapies were administered to 1373 patients (56.7%). These therapies included administration of analgesics, sedation, mouth care, repositioning for comfort (as appropriate) and provision of emotional support to the patient and his/her relatives. These palliative measures were provided more frequently in the observation unit of the ED (n=908, 66.2%) than in an examination room (n=465, 33.8%). Median time interval between ED admission and death was longer in patients who received palliative care (n=1373) (median, 15 h; first quartile, 6 h; third quartile, 34 h) than in those who did not (n=1047) (median, 4 h; first quartile, 1 h; third quartile, 10 h) (p<10−4).ConclusionsPalliative care is administered to about half of the patients who die in EDs. This is insufficient as the majority of the patients who died in EDs actually died after a decision to withhold or withdraw life-support therapies. End-of-life management must be improved in EDs.