title: A Literature Review on Care at the End-of-Life in the Emergency Department.
abstract: The hospitalisation and management of patients at the end-of-life by emergency medical services is presenting a challenge to our society as the majority of people approaching death explicitly state that they want to die at home and the transition from acute care to palliation is difficult. In addition, the escalating costs of providing care at the end-of-life in acute hospitals are unsustainable. Hospitals in general and emergency departments in particular cannot always provide the best care for patients approaching end-of-life. The main objectives of this paper are to review the existing literature in order to assess the evidence for managing patients dying in the emergency department, and to identify areas of improvement such as supporting different models of care and evaluating those models with health services research. The paper identified six main areas where there is lack of research and/or suboptimal policy implementation. These include uncertainty of treatment in the emergency department; quality of life issues, costs, ethical and social issues, interaction between ED and other health services, and strategies for out of hospital care. The paper concludes with some areas for policy development and future research.
authors.affiliation: Simpson Centre for Health Services Research, South Western Sydney Clinical School (Liverpool Hospital) and The Australian Institute of Health Innovation (AIHI), University of New South Wales, Level 1, AGSM Building (G27), Kensington Campus, Gate 11, Botany Street, Randwick, NSW 2052, Australia.
authors.forename: Roberto
authors.initials: R
authors.lastname: Forero
authors.forename: Geoff
authors.initials: G
authors.lastname: McDonnell
authors.forename: Blanca
authors.initials: B
authors.lastname: Gallego
authors.forename: Sally
authors.initials: S
authors.lastname: McCarthy
authors.forename: Mohammed
authors.initials: M
authors.lastname: Mohsin
authors.forename: Chris
authors.initials: C
authors.lastname: Shanley
authors.forename: Frank
authors.initials: F
authors.lastname: Formby
authors.forename: Ken
authors.initials: K
authors.lastname: Hillman