title: Reasons for transferral to emergency departments of terminally ill patients - a French descriptive and retrospective study.
abstract: BACKGROUND
  Patients under palliative care and in hospital-at-home services are frequently transferred to emergency departments. We set out to identify the reasons for these presentations to determine the proportion that might be avoidable.
  
  
  METHODS
  We conducted a retrospective study by assessment of patient files. We studied admissions to four emergency departments in an area of France (Puy-de-Dôme) between September 2011 and August 2013. Reasons for transfer and diagnostic conclusion by emergency doctors were noted. We collected date of admission, time spent, investigations and treatments performed and patients' outcomes after the medical conclusions. We also determined whether patients called the hospital-at-home service before going to the emergency department. From these data we discerned potentially avoidable and unavoidable consultations.
  
  
  RESULTS
  We identified 52 transfers of patients from home to emergency departments. The most frequent reasons were: generalized weakness (11 cases), social isolation (8 cases) and end of life (7 cases). For 58 % of presentations, the investigations and treatments performed did not require presentation to an emergency department; 34 % of patients returned home after the visit, 41 % remained for simple observation and 20 % remained to receive special care. Two patients died in the emergency department. In 86 % of cases, presentations occurred when primary care was less readily available, and patients called home care services in only 42 % of cases before going to emergency departments.
  
  
  CONCLUSIONS
  Half of the transfers to emergency departments were potentially avoidable for terminally ill patients in home care. To reduce this proportion we need to promote access to primary care, educate patients in hospital-at-home service and train care-givers and doctors in palliative medicine.
authors: Department of Palliative Care, Centre hospitalier Universitaire, Hopital Nord, 63000, Clermont-Ferrand, France. pierre.cornillon@chu-clermontferrand.fr.
authors: Pierre
authors: http://orcid.org/0000-0002-9569-4134
authors: P
authors: Cornillon
authors: Emergency Department, Centre Hospitalier d'Issoire, Issoire, France.
authors: Sébastien
authors: S
authors: Loiseau
authors: Department of Palliative Care, Centre hospitalier Universitaire, Hopital Nord, 63000, Clermont-Ferrand, France.
authors: Bruno
authors: B
authors: Aublet-Cuvelier
authors: Department of Palliative Care, Centre hospitalier Universitaire, Hopital Nord, 63000, Clermont-Ferrand, France.
authors: Virginie
authors: V
authors: Guastella
mesh_terms: D000293:Adolescent; D000328:Adult; D016223:Advance Directives; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005602:France; D006297:Health Services Accessibility; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D018908:Muscle Weakness; D009369:Neoplasms / Q000628:therapy*; D019636:Neurodegenerative Diseases / Q000628:therapy*; D010166:Palliative Care; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011320:Primary Health Care; D012189:Retrospective Studies; D012934:Social Isolation; D013727:Terminal Care; D019452:Terminally Ill; D055815:Young Adult
keywords: Avoidable presentations; Emergency departments; Hospital-at-home; Palliative care