Why do palliative care patients present to the emergency department? Avoidable or unavoidable?
BACKGROUND
Presentations by patients with advanced illness to the Emergency Department (ED) towards the end-of-life can be distressing for both patients and caregivers. With an understanding of why patients present, interventions to avoid these presentations close to the end-of-life may be possible.


OBJECTIVE
To identify patients under the specialist palliative care service (SPCS) who attended the ED over 6 months and to determine if these presentations were potentially avoidable. Presentations were deemed avoidable if the problem could have been dealt with in another manner, i.e. by the home care team or by the family physician, or in another setting, such as by admission to the hospice.


RESULTS
Thirty-five ED presentations by 30 patients were included. Eighteen (60%) male, mean age 68.7 (47-89). Twenty-two (63%) ED presentations were outside working hours. The main reasons for attending were: dyspnea (9, 26%), nausea/vomiting/constipation (6, 17%) and uncontrolled pain (5, 14.5%). Thirty-three (94%) of the 35 presentations resulted in hospitalization. The average length of time spent in the ED was 9.2 hours (3-24). Referral to the hospital SPCS was made in 20 (60%) cases. Fifteen (50%) patients died within one month of presentation. Eighteen (51.5%) ED presentations were deemed potentially avoidable.


CONCLUSIONS
Many ED presentations by palliative care patients may be avoidable. Appropriate sharing of information to on-call doctors, creating confidence in carers and providing extra practical supports is necessary. A comprehensive, coordinated specialist palliative care approach across community and acute services may help ensure patients are not sent to the ED inappropriately.
Department of Palliative Medicine, Mid-Western Regional Hospital, Dooradoyle, Limerick, Ireland. drelainewallace@gmail.com
Elaine M
EM
Wallace
Mary C
MC
Cooney
Jackie
J
Walsh
Marian
M
Conroy
Feargal
F
Twomey
D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000517:prevention & control / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010166:Palliative Care / Q000592:standards / Q000706:statistics & numerical data*