1
|
Albanesi B, Conti A, Politano G, Dimonte V, Gianino MM, Campagna S. Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019. BMC Geriatr 2024; 24:295. [PMID: 38549053 PMCID: PMC10976813 DOI: 10.1186/s12877-024-04912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/21/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Visits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits. METHODS A retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits. RESULTS In 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51-1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08-2.31). CONCLUSIONS Our study indicates that more than half of NH residents' ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.
Collapse
Affiliation(s)
- Beatrice Albanesi
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Alessio Conti
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy.
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Turin, Italy
| | - Valerio Dimonte
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Maria Michela Gianino
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Sara Campagna
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| |
Collapse
|
2
|
Sanders S, Cheung WJ, Bakewell F, Landreville JM, Rangel C, D'Egidio G, Eagles D. How Emergency Medicine Residents Have Conversations About Life-Sustaining Treatments in Critical Illness: A Qualitative Study Using Inductive Thematic Analysis. Ann Emerg Med 2023; 82:583-593. [PMID: 37074255 DOI: 10.1016/j.annemergmed.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 03/07/2023] [Accepted: 03/13/2023] [Indexed: 04/20/2023]
Abstract
STUDY OBJECTIVE The inherent pressures of high-acuity, critical illness in the emergency department create a unique environment whereby acute goals-of-care discussions must be had with patients or substitute decision makers to rapidly decide between divergent treatment paths. Among university-affiliated hospitals, resident physicians are often conducting these highly consequential discussions. This study aimed to use qualitative methods to explore how emergency medicine residents make recommendations regarding life-sustaining treatments during acute goals-of-care discussions in critical illness. METHODS Using qualitative methods, semistructured interviews were conducted with a purposive sample of emergency medicine residents in Canada from August to December 2021. Inductive thematic analysis of the interview transcripts was conducted using line-by-line coding, and key themes were identified through comparative analysis. Data collection continued until thematic saturation was reached. RESULTS Seventeen emergency medicine residents from 9 Canadian universities were interviewed. Two factors guided residents' treatment recommendations (a duty to provide a recommendation and the balance between disease prognosis and patient values). Three factors influenced residents' comfort when making recommendations (time constraints, uncertainty, and moral distress). CONCLUSION While conducting acute goals-of-care discussions with critically ill patients or their substitute decision makers in the emergency department, residents felt a sense of duty to provide a recommendation informed by an intersection between the patient's disease prognosis and the patient's values. Their comfort in making these recommendations was limited by time constraints, uncertainty, and moral distress. These factors are important for informing future educational strategies.
Collapse
Affiliation(s)
- Steven Sanders
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario.
| | - Warren J Cheung
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario
| | - Francis Bakewell
- Department of Emergency Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Cristian Rangel
- Department of Medicine, University of Ottawa, Ottawa, Ontario
| | - Gianni D'Egidio
- Department of Critical Care, University of Ottawa, Ottawa, Ontario
| | - Debra Eagles
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario
| |
Collapse
|
3
|
Emergency department staff perceptions of their roles in providing end of life care. Australas Emerg Care 2022:S2588-994X(22)00070-7. [DOI: 10.1016/j.auec.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/18/2022]
|
4
|
Ryan K, Windsor C, Jack L. The phenomenon of caring for older patients who are dying from traumatic injuries in the emergency department: An interpretive phenomenological study. J Nurs Scholarsh 2022; 54:562-568. [PMID: 35076153 PMCID: PMC9546414 DOI: 10.1111/jnu.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/30/2021] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
Purpose To gain greater understanding of what it means to care for older patients dying from traumatic injuries in the emergency department. Design A Heideggerian phenomenological design using the methods of Van Manen. Methods In‐depth, face‐to‐face interviews were conducted with five emergency nurses who worked in an emergency department in Australia. Interview data were interpreted using a Heideggerian hermeneutic approach and guided by Van Manen’s lifeworld analysis focusing on the experiential aspects of lived time (temporality) and lived space (spatiality) in the phenomenon. Findings The older patient reflects the passage of chronological time. This temporal aspect shaped the participant experience as there was a sudden awareness of the impact of the injuries sustained on the fragile physical condition of the patients. There was an unexpectedness and unpreparedness which was related to a precognitive assumption that the older patient would die from an age‐related comorbid condition. Also of significance was the sacred liminal space in which the nurses worked to facilitate the dying patient transition from life to death. Conclusions The existential dimensions of temporality and spatiality revealed new insights into what it means to care for elderly patients dying from traumatic injuries. Temporal aspects were shaped by the longevity of the lives of patients and spatiality explored the liminal space where participants were morally guided to deliver end of life care with dignity and respect for a long‐lived life taken by trauma. Clinical relevance The findings may contribute to further understanding of what shapes the experience for emergency nurses delivering EOL care in the ED, with specific relevance and focus on the older patient with traumatic injuries. Hermeneutic research may also encourage clinicians to explore phenomena to reveal new understandings that will inform further dialogue and future research.
Collapse
Affiliation(s)
- Kimberley Ryan
- Emergency and Trauma Centre, Royal Brisbane Women's Hospital, Brisbane, Queensland, Australia.,School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Carol Windsor
- School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| | - Leanne Jack
- School of Nursing, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Queensland, Australia
| |
Collapse
|
5
|
Aaronson EL, Greenwald JL, Krenzel LR, Rogers AM, LaPointe L, Jacobsen JC. Adapting the serious illness conversation guide for use in the emergency department by social workers. Palliat Support Care 2021; 19:681-685. [PMID: 34140064 DOI: 10.1017/s1478951521000821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although important treatment decisions are made in the Emergency Department (ED), conversations about patients' goals and values and priorities often do not occur. There is a critical need to improve the frequency of these conversations, so that ED providers can align treatment plans with these goals, values, and priorities. The Serious Illness Conversation Guide has been used in other care settings and has been demonstrated to improve the frequency, quality, and timing of conversations, but it has not been used in the ED setting. Additionally, ED social workers, although integrated into hospital and home-based palliative care, have not been engaged in programs to advance serious illness conversations in the ED. We set out to adapt the Serious Illness Conversation Guide for use in the ED by social workers. METHODS We undertook a four-phase process for the adaptation of the Serious Illness Conversation Guide for use in the ED by social workers. This included simulated testing exercises, pilot testing, and deployment with patients in the ED. RESULTS During each phase of the Guide's adaptation, changes were made to reflect both the environment of care (ED) and the clinicians (social workers) that would be using the Guide. A final guide is presented. SIGNIFICANCE OF RESULTS This report presents an adapted Serious Illness Conversation Guide for use in the ED by social workers. This Guide may provide a tool that can be used to increase the frequency and quality of serious illness conversations in the ED.
Collapse
Affiliation(s)
- Emily Loving Aaronson
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians' Organization, Boston, MA
| | - Jeffrey L Greenwald
- Core Educator Faculty, Department of Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lindsey R Krenzel
- Department of Social Work, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Angelina M Rogers
- Department of Social Work, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lauren LaPointe
- Department of Social Work, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Juliet C Jacobsen
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
6
|
Nalugya LG, Harborne D, Reid E. Factors affecting initiation of palliative care in a Ugandan Emergency Department. Afr J Emerg Med 2021; 11:442-446. [PMID: 34765429 PMCID: PMC8568603 DOI: 10.1016/j.afjem.2021.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 04/30/2021] [Accepted: 06/04/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction The Emergency Department (ED) of Mbarara Regional Referral Hospital serves a largely rural population of 4 million people in western Uganda. Here, ED patients with incurable illness often have prolonged stays. Palliative care (PC) is a low-cost intervention that focuses on alleviating pain and suffering for patients with incurable disease, while improving satisfaction with care and optimizing healthcare utilization. This is especially important in low resource settings. A prior needs assessment in our ED revealed that 50% of patients have PC needs. The ED is an optimal location to initiate PC, yet this rarely happens. There is a great need to identify factors affecting initiation of ED PC in our resource-limited setting. Methods A semi-structured questionnaire and chart review was conducted from March to August 2020. Patients admitted from the ED were assessed for PC needs. Those who met criteria were approached for inclusion and flagged for initiation of PC. The follow-up period was 7 days. Results Sixty two percent of those subjects flagged for initiation of PC received it. By day seven, 36.1 of the study population had died. ED initiation of PC varied significantly by diagnosis, with cancer patients more likely to receive PC (p = 0.0097). Conclusion Important barriers to PC initiation were identified in our Ugandan ED, related to diagnosis. These barriers could be overcome by improving awareness of PC amongst patients and providers alike and implementing a PC screening tool for all admissions. Future research is needed to identify other barriers, as well as strategies for improved hospital-wide uptake of PC in this resource-limited setting.
Collapse
|
7
|
Oncological Assistance in the Emergency Room Setting: The Role of a Dedicated Oncology Unit. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2021. [DOI: 10.5812/ijcm.110512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The appearance of symptoms that may be related to the worsening of the disease, as well as the toxicity of chemotherapy treatment or an acute complication, are the most frequent reasons for access to the emergency room (ER) for patients with cancer. To date, the Italian territorial health services, as well as local preventive medicine, are unable to provide adequate management of patients with cancer and, for this reason, diagnostic delays and inappropriate hospitalization in the oncology departments have occurred; moreover, it has been observed that many patients receive the first diagnosis of cancer directly in the ER, where the experience in the oncology field is often inadequate. Objectives: Cardarelli Hospital, in Naples, started twenty-two month Experimental Oncological Emergency Service, under the supervision of its own Oncology Department, with the double main objectives of encouraging de-hospitalization and improving diagnostic and therapeutic performance. Methods: We have developed a methodological protocol for patients’ admission to the ER, assuming that the host physician transfers patients with suspected cancer to a new hospital figure, the ER oncologist, who acts as supervisor and coordinator. The first consultation was carried out together with one or more specialists, identified by the supervisor. Based on their characteristics, the patients were divided into 4 categories: (1) Patients with a known diagnosis of cancer and already undergoing anticancer treatments; (2) patients who show complications due to ongoing cancer treatments; (3) patients who no longer respond to anticancer treatments due to the worsening of the disease; (4) patients who are first diagnosed with cancer in the ER. Each individual cohort of patients was directed towards what we have called diagnostic-therapeutic assistance paths (PDTA), specific protocols for each type of patient, which allowed us to reduce the time to diagnosis. Results: According to the data, the average hospitalization time for patients with lung cancer who followed the study was 10 days, compared to 16 days for patients who did not undergo cancer screening in the ER. Another relevant result demonstrated the improvement in the quality and efficiency of medical services by including first aid in the management of cancer patients regards de-hospitalization. In fact, thanks to the experimental protocol we applied, we were able to de-hospitalize 484 patients directly from the ER, which are over 34% of the total. Conclusions: Close integration between hospital medical fields and territorial medicine could improve the quality of cancer treatment and the efficiency of health services management. All of this without affecting the costs of public healthcare because of the considerable improvement in performance which allowed important savings.
Collapse
|
8
|
Loffredo AJ, Chan GK, Wang DH, Goett R, Isaacs ED, Pearl R, Rosenberg M, Aberger K, Lamba S. United States Best Practice Guidelines for Primary Palliative Care in the Emergency Department. Ann Emerg Med 2021; 78:658-669. [PMID: 34353647 DOI: 10.1016/j.annemergmed.2021.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
The growing palliative care needs of emergency department (ED) patients in the United States have motivated the development of ED primary palliative care principles. An expert panel convened to develop best practice guidelines for ED primary palliative care to help guide frontline ED clinicians based on available evidence and consensus opinion of the panel. Results include recommendations for screening and assessment of palliative care needs, ED management of palliative care needs, goals of care conversations, ED palliative care and hospice consults, and transitions of care.
Collapse
Affiliation(s)
- Anthony J Loffredo
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Garrett K Chan
- Department of Physiologic Nursing, University of California, San Francisco, CA
| | - David H Wang
- Division of Palliative Medicine, Scripps Health, San Diego, CA
| | - Rebecca Goett
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Eric D Isaacs
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - Rachel Pearl
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark Rosenberg
- Department of Emergency Medicine, St Joseph's Health, Paterson and Wayne, NJ
| | - Kate Aberger
- Division of Palliative Medicine and Geriatrics, St Joseph's Health, Paterson, NJ; Department of Emergency Medicine, Robert Wood Johnson University Hospital Somerset, Somerville, NJ
| | - Sangeeta Lamba
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
| |
Collapse
|
9
|
Sorge R, DeBlieux P. Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Primer for Emergency Physicians. J Emerg Med 2020; 59:643-659. [PMID: 32917442 DOI: 10.1016/j.jemermed.2020.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/24/2020] [Accepted: 07/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose a significant burden on patients and the emergency health care system. Patients with COPD who present to the emergency department (ED) often have comorbidities that can complicate their management. OBJECTIVE To discuss strategies for the management of acute exacerbations in the ED, from initial assessment through disposition, to enable effective patient care and minimize the risk of treatment failure and prevent hospital readmissions. DISCUSSION Establishing a correct diagnosis early on is critical; therefore, initial evaluations should be aimed at differentiating COPD exacerbations from other life-threatening conditions. Disposition decisions are based on the intensity of symptoms, presence of comorbidities, severity of the disease, and response to therapy. Patients who are appropriate for discharge from the ED should be prescribed evidence-based treatments and smoking cessation to prevent disease progression. A patient-centric discharge care plan should include medication reconciliation; bedside "teach-back," wherein patients demonstrate proper inhaler usage; and prompt follow-up. CONCLUSIONS An effective assessment, accurate diagnosis, and appropriate discharge plan for patients with AECOPD could improve treatment outcomes, reduce hospitalization, and decrease unplanned repeat visits to the ED.
Collapse
Affiliation(s)
- Randy Sorge
- Department of Medicine, Section of Emergency Medicine, Louisiana State University Health Sciences Center, University Medical Center, New Orleans, Louisiana
| | - Peter DeBlieux
- Department of Medicine, Section of Emergency Medicine, Louisiana State University Health Sciences Center, University Medical Center, New Orleans, Louisiana
| |
Collapse
|
10
|
Bylicki O, Didier M, Riviere F, Margery J, Grassin F, Chouaid C. Lung cancer and end-of-life care: a systematic review and thematic synthesis of aggressive inpatient care. BMJ Support Palliat Care 2019; 9:413-424. [PMID: 31473652 PMCID: PMC6923940 DOI: 10.1136/bmjspcare-2019-001770] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 07/30/2019] [Accepted: 08/14/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Despite recent advances in thoracic oncology, most patients with metastatic lung cancer die within months of diagnosis. Aggressiveness of their end-of-life (EOL) care has been the subject of numerous studies. This study was undertaken to evaluate the literature on aggressive inpatient EOL care for lung cancer and analyse the evolution of its aggressiveness over time. METHODS A systematic international literature search restricted to English-language publications used terms associated with aggressiveness of care, EOL and their synonyms. Two independent researchers screened for eligibility and extracted all data and another a random 10% sample of the abstracts. Electronic Medline and Embase databases were searched (2000-20 September 2018). EOL-care aggressiveness was defined as follows: 1) chemotherapy administered during the last 14 days of life (DOL) or new chemotherapy regimen during the last 30 DOL; 2) >2 emergency department visits; 3) >1 hospitalisation during the last 30 DOL; 4) ICU admission during the last 30 DOL and 5) palliative care started <3 days before death. RESULTS Among the 150 articles identified, 42 were retained for review: 1 clinical trial, 3 observational cohorts, 21 retrospective analyses and 17 administrative data-based studies. The percentage of patients subjected to aggressive therapy seems to have increased over time. Early management by palliative care teams seems to limit aggressive care. CONCLUSIONS Our analysis indicated very frequent aggressive EOL care for patients with lung cancer, regardless of the definition used. The extent of that aggressiveness and its impact on healthcare costs warrant further studies.
Collapse
Affiliation(s)
- Olivier Bylicki
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Morgane Didier
- Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| | - Frederic Riviere
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Jacques Margery
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Frederic Grassin
- Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
| | - Christos Chouaid
- Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France
| |
Collapse
|
11
|
Zeng H, Eugene P, Supino M. Would You Be Surprised if This Patient Died in the Next 12 Months? Using the Surprise Question to Increase Palliative Care Consults From the Emergency Department. J Palliat Care 2019; 35:221-225. [PMID: 31394970 DOI: 10.1177/0825859719866698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND There is a growing movement to increase palliative care consults from the emergency department (ED) to reduce healthcare costs and improve quality of life. The surprise question is a screening tool that emergency medicine physicians may be able to use towards achieving this goal. OBJECTIVE The objectives of this study were to increase awareness of hospice and palliative care medicine (HPM) among emergency medicine (EM) providers and to evaluate whether this heightened awareness increased palliative care consults among participating emergency medicine providers. METHODS We conducted an anonymous convenience sample survey and two educational interventions about HPM including the surprise question among emergency medicine resident and attending physicians at a large urban public academic quaternary care center from July to November 2018. A report of palliative care consults ordered between August 1, 2017 and January 1, 2019 was generated from the electronic health records used by the hospital. The number of palliative care consults made before and after the educational intervention was compared. RESULTS After the first educational intervention centered on the surprise question, palliative care consults from the ED increased from an average of 2.25 per month (range 0 to 8, SD: 2.38) to 12.67 per month (range 9 to 19, SD: 4.01, p < .001). CONCLUSION Educating EM physicians about the surprise question can increase the number of palliative care consults from the ED, thereby potentially improving patient care and decreasing costs by avoiding unwanted healthcare interventions.
Collapse
Affiliation(s)
- Henry Zeng
- Department of Emergency Medicine, 23214Jackson Memorial Hospital, Miami, FL, USA
| | - Paul Eugene
- Department of Emergency Medicine, 23214Jackson Memorial Hospital, Miami, FL, USA
| | - Mark Supino
- Department of Emergency Medicine, 23214Jackson Memorial Hospital, Miami, FL, USA
| |
Collapse
|
12
|
Aaronson EL, George N, Ouchi K, Zheng H, Bowman J, Monette D, Jacobsen J, Jackson V. The Surprise Question Can Be Used to Identify Heart Failure Patients in the Emergency Department Who Would Benefit From Palliative Care. J Pain Symptom Manage 2019; 57:944-951. [PMID: 30776539 PMCID: PMC6713219 DOI: 10.1016/j.jpainsymman.2019.02.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Heart failure (HF) is associated with symptom exacerbations and risk of mortality after an emergency department (ED) visit. Although emergency physicians (EPs) treat symptoms of HF, often the opportunity to connect with palliative care is missed. The "surprise question" (SQ) "Would you be surprised if this patient died in the next 12 months?" is a simple tool to identify patients at risk for 12-month mortality. OBJECTIVES The objective of this study was to assess the accuracy of the SQ when used by EPs to assess patients with HF. METHODS We conducted a prospective cohort study in which clinicians applied the SQ to patients presenting to the ED with symptoms of HF. Chart review and review of death records were completed. The primary outcome was accuracy of the surprise question to predict 12-month mortality. A univariate analysis for potential predictors of 12-month mortality was performed. RESULTS During the study period, 199 patients were identified, and complete data were available for 97% of observations (n = 193). The one-year mortality was 29%. EPs reported that "they would not be surprised" if the patient died within the next 12 months in 53% of cases. 42.7% of these patients died within 12 months compared to 13.3% in the "would be surprised" group. There was a strong association with death in the "not surprised" group (odds ratio 4.85, 95% CI 2.34-9.98, P < 0.0001). The sensitivity, specificity, positive predictive value, and negative predictive value of the SQ were 78.6%, 56.9%, 42.7%, and 86.7%, respectively, with c-statistic = 0.68. CONCLUSION The SQ screening tool can assist ED providers in identifying HF patients that would benefit from early palliative care involvement.
Collapse
Affiliation(s)
- Emily L Aaronson
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians' Organization, Boston, Massachusetts, USA.
| | - Naomi George
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Hui Zheng
- Biostatistic Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason Bowman
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Derek Monette
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Juliet Jacobsen
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki Jackson
- Division of Palliative Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
13
|
McCallum KJ, Jackson D, Walthall H, Aveyard H. Exploring the quality of the dying and death experience in the Emergency Department: An integrative literature review. Int J Nurs Stud 2018; 85:106-117. [DOI: 10.1016/j.ijnurstu.2018.05.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/17/2018] [Accepted: 05/22/2018] [Indexed: 10/16/2022]
|
14
|
Vaittinada Ayar P, Ayllon-Milla S, Damas-Perrichet C, Villoing B, Doumenc B, Dumas F. Évaluation des prises de décisions de limitations et d’arrêt des thérapeutiques chez les patients décédés aux urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2018. [DOI: 10.3166/afmu-2018-0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction : Les décisions de limitation et arrêt des thérapeutiques (LAT) sont encadrées par la loi du 22 avril 2005 relative aux droits des malades et à la fin de vie. Au lendemain de sa révision, le 2 février 2016, cette situation reste toujours aussi complexe aux urgences. Notre travail avait pour but d’évaluer la prise de décision des limitations de soins aux urgences.
Matériel et méthode : Il s’agissait d’une étude rétrospective, observationnelle, monocentrique. Le recueil des données a été fait par une relecture des dossiers concernant les patients décédés entre le 1er janvier 2014 et le 5 mai 2015. L’objectif de notre travail était de décrire les modalités de prise de décision de limitations de soins, ainsi que leur adéquation avec la loi.
Résultats : Nous avions inclus 91 dossiers de patients décédés. Parmi les 58 dossiers (64%) où l’autonomie était retrouvée, elle était très limitée chez 50 patients (Knaus C + D), soit 86%. La décision était inscrite dans 74 dossiers (81%), mais détaillée dans 40 seulement (44%). Soixante-quinze fois (83%), la famille a été informée. Dans 70 (80%) des 87 situations où les intervenants étaient identifiés, la procédure collégiale était respectée. Une thérapeutique palliative a été initiée chez 67 des défunts (74%).
Conclusion : Les décisions de LAT sont encore perfectibles aux urgences pour être en adéquation avec la loi. Des améliorations sont possibles en intégrant des programmes de formations du personnel et des protocoles éthiques d’aide à la décision.
Collapse
|
15
|
Shoenberger J, Lamba S, Goett R, DeSandre P, Aberger K, Bigelow S, Brandtman T, Chan GK, Zalenski R, Wang D, Rosenberg M, Jubanyik K. Development of Hospice and Palliative Medicine Knowledge and Skills for Emergency Medicine Residents: Using the Accreditation Council for Graduate Medical Education Milestone Framework. AEM EDUCATION AND TRAINING 2018; 2:130-145. [PMID: 30051080 PMCID: PMC6001832 DOI: 10.1002/aet2.10088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/25/2018] [Accepted: 01/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Emergency medicine (EM) physicians commonly care for patients with serious life-limiting illness. Hospice and palliative medicine (HPM) is a subspecialty pathway of EM. Although a subspecialty level of practice requires additional training, primary-level skills of HPM such as effective communication and symptom management are part of routine clinical care and expected of EM residents. However, unlike EM residency curricula in disciplines like trauma and ultrasound, there is no nationally defined HPM curriculum for EM resident training. An expert consensus group was convened with the aim of defining content areas and competencies for HPM primary-level practice in the ED setting. Our overall objective was to develop HPM milestones within a competency framework that is relevant to the practice of EM. METHODS The American College of Emergency Physicians Palliative Medicine Section assembled a committee that included academic EM faculty, community EM physicians, EM residents, and nurses, all with interest and expertise in curricular design and palliative medicine. RESULTS The committee peer reviewed and assessed HPM content for validity and importance to EM residency training. A topic list was developed with three domains: provider skill set, clinical recognition of HPM needs, and logistic understanding related to HPM in the ED. The group also developed milestones in HPM-EM to identify relevant knowledge, skills, and behaviors using the framework modeled after the Accreditation Council for Graduate Medical Education (ACGME) EM milestones. This framework was chosen to make the product as user-friendly and familiar as possible to facilitate use by EM educators. CONCLUSIONS Educators in EM residency programs now have access to HPM content areas and milestones relevant to EM practice that can be used for curriculum development in EM residency programs. The HPM-EM skills/competencies presented herein are structured in a familiar milestone framework that is modeled after the widely accepted ACGME EM milestones.
Collapse
Affiliation(s)
- Jan Shoenberger
- Keck School of Medicine of the University of Southern CaliforniaLos AngelesCA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Spiritual perspectives of emergency medicine doctors and nurses in caring for end-of-life patients: A mixed-method study. Int Emerg Nurs 2018; 37:13-22. [DOI: 10.1016/j.ienj.2017.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 06/26/2017] [Accepted: 07/01/2017] [Indexed: 11/20/2022]
|
17
|
Díaz-Cortés MDM, Granero-Molina J, Hernández-Padilla JM, Pérez Rodríguez R, Correa Casado M, Fernández-Sola C. Promoting dignified end-of-life care in the emergency department: A qualitative study. Int Emerg Nurs 2018; 37:23-28. [DOI: 10.1016/j.ienj.2017.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 05/11/2017] [Accepted: 05/28/2017] [Indexed: 10/19/2022]
|
18
|
Philip J, Remedios C, Breen S, Weiland T, Willenberg L, Boughey M, Jelinek G, Lane H, Marck C, Weil J. The experiences of patients with advanced cancer and caregivers presenting to Emergency Departments: A qualitative study. Palliat Med 2018; 32:439-446. [PMID: 29130378 DOI: 10.1177/0269216317735724] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite being a common event in the course of an advanced cancer illness, there is little understanding of patients' perceptions of hospital Emergency Department presentations. AIM To explore the experiences and perceptions of Emergency Departments held by patients with advanced cancer and their informal caregivers. DESIGN Cross-sectional study involving semi-structured interviews with advanced cancer patients and their informal caregivers. Qualitative data analysis was underpinned by a phenomenological approach utilising a data-driven inductive thematic frame. SETTING/PARTICIPANTS In total, 19 patients with advanced cancer who presented to Emergency Departments in the previous 6 months and 10 informal caregivers from an Australian public hospital and community palliative care service were interviewed. RESULTS Patients reported that Emergency Department presentations were largely prompted by worsening symptoms or were a means to expedite hospital admission, with many instructed to attend by their health care provider. The experience in the Emergency Department was described as a time of anxiety and uncertainty with concerns over communication, the general environment and delays in the symptom management highlighted. Long waits were common. Despite this, patients described relief at receiving care. While the Emergency Department was viewed as a safety net for the health system, many believed advanced cancer patients should have alternative options. CONCLUSION Relatively simple changes of regular communication updates and early symptom relief would improve patient experience of Emergency Department care. However, since an Emergency Department presentation is frequently serving as a default to access medical care, a significant re-orientation of the health care system is required to meet patient needs.
Collapse
Affiliation(s)
- Jennifer Philip
- 1 Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia.,2 Victorian Comprehensive Cancer Centre, Parkville, VIC, Australia.,3 Palliative Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | | | - Sibilah Breen
- 1 Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Tracey Weiland
- 5 Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Mark Boughey
- 3 Palliative Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - George Jelinek
- 5 Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Heather Lane
- 7 Rockingham General Hospital, Rockingham, WA, Australia
| | - Claudia Marck
- 5 Neuroepidemiology Unit, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Weil
- 3 Palliative Medicine, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| |
Collapse
|
19
|
McIntosh M, Monticalvo D, Quest T, Adkins B, Bell S, Osian SR. A dedicated palliative care nurse improves access to palliative care and hospice services in an urban ED. Am J Emerg Med 2016; 34:2440-2441. [DOI: 10.1016/j.ajem.2016.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 08/15/2016] [Accepted: 08/16/2016] [Indexed: 11/15/2022] Open
|
20
|
Kraus CK, Greenberg MR, Ray DE, Dy SM. Palliative Care Education in Emergency Medicine Residency Training: A Survey of Program Directors, Associate Program Directors, and Assistant Program Directors. J Pain Symptom Manage 2016; 51:898-906. [PMID: 26988848 DOI: 10.1016/j.jpainsymman.2015.12.334] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/18/2015] [Accepted: 12/24/2015] [Indexed: 11/25/2022]
Abstract
CONTEXT Emergency medicine (EM) residents perceive palliative care (PC) skills as important and want training, yet there is a general lack of formal PC training in EM residency programs. A clearer definition of the PC educational needs of EM trainees is a research priority. OBJECTIVES To assess PC competency education in EM residency programs. METHODS This was a mixed-mode survey of residency program directors, associate program directors, and assistant program directors at accredited EM residency programs, evaluating four educational domains: 1) importance of specific competencies for senior EM residents, 2) senior resident skills in PC competencies, 3) effectiveness of educational methods, and 4) barriers to training. RESULTS Response rate was 50% from more than 100 residency programs. Most respondents (64%) identified PC competencies as important for residents to learn, and 59% reported that they teach7 PC skills in their residency program. In Domains 1 and 2, crucial conversations, management of pain, and management of the imminently dying had the highest scores for importance and residents' skill. In Domain 3, bedside teaching, mentoring from hospice and palliative medicine faculty, and case-based simulation were the most effective educational methods. In Domain 4, lack of PC expertise among faculty and lack of interest by faculty and residents were the greatest barriers. There were differences between competency importance and senior resident skill level for management of the dying child, withdrawal/withholding of nonbeneficial interventions, and ethical/legal issues. CONCLUSION There are specific barriers and opportunities for PC competency training and gaps in resident skill level. Specifically, there are discrepancies in competency importance and residency skill in the management of the dying child, nonbeneficial interventions, and ethical and legal issues that could be a focus for educational interventions in PC competency training in EM residencies.
Collapse
Affiliation(s)
- Chadd K Kraus
- Department of Emergency Medicine, University of Missouri-Columbia, Columbia, Missouri, USA.
| | - Marna R Greenberg
- Department of Emergency Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Daniel E Ray
- Section of Palliative Medicine and Hospice, Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Sydney Morss Dy
- Duffey Pain/Palliative Care Program, Johns Hopkins Kimmel Cancer Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
21
|
Tse JWK, Hung MSY, Pang SMC. Emergency Nurses' Perceptions of Providing End-of-Life Care in a Hong Kong Emergency Department: A Qualitative Study. J Emerg Nurs 2016; 42:224-32. [PMID: 27033338 DOI: 10.1016/j.jen.2015.10.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 09/11/2015] [Accepted: 10/19/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Provision of end-of-life (EOL) care in the emergency department has improved globally in recent years and has a different scope of interventions than traditional emergency medicine. In 2010, a regional hospital established the first ED EOL service in Hong Kong. METHODS The aim of this study was to understand emergency nurses' perceptions regarding the provision of EOL care in the emergency department. A qualitative approach was used with purposive sampling of 16 nurses who had experience in providing EOL care. Semi-structured, face-to-face interviews were conducted from May to October, 2014. All the interviews were transcribed verbatim for content analysis. RESULTS Four themes were identified: (1) doing good for the dying patients, (2) facilitating family engagement and involvement, (3) enhancing personal growth and professionalism, and (4) expressing ambiguity toward resource deployment. DISCUSSION Provision of EOL care in the emergency department can enhance patients' last moment of life, facilitate the grief and bereavement process of families, and enhance the professional development of staff in emergency department. It is substantiated that EOL service in the emergency department enriches EOL care in the health care system. Findings from this study integrated the perspectives on ED EOL services from emergency nurses. The integration of EOL service in other emergency departments locally and worldwide is encouraged.
Collapse
Affiliation(s)
| | - Maria Shuk Yu Hung
- Hong Kong Special Administrative Region of the People's Republic of China
| | | |
Collapse
|
22
|
Basol N. The Integration of Palliative Care into the Emergency Department. Turk J Emerg Med 2016; 15:100-7. [PMID: 27336074 PMCID: PMC4910008 DOI: 10.5505/1304.7361.2015.65983] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 01/12/2015] [Indexed: 11/04/2022] Open
Abstract
Palliative care (PC) is a new and developing area. It aims to provide the best possible quality of life for patients with life-limiting diseases. It does not primarily include life-extending therapies, but rather tries to help patients spend the rest of their lives in the best way. PC patients often are admitted to emergency departments during the course of a disease. The approach and management of PC include differences with emergency medicine. Thus, there are some problems while providing PC in the ED. With this article, the definition, main features, benefits, and problems of providing PC are presented, with the primary aim of emphasizing the importance of PC integration into the ED.
Collapse
Affiliation(s)
- Nursah Basol
- Department of Emergency Medicine, Gaziosmanpasa University Faculty of Medicine, Tokat, Turkey
| |
Collapse
|
23
|
Revels A, Goldberg L, Watson J. Caring Science: A Theoretical Framework for Palliative Care in the Emergency Department. ACTA ACUST UNITED AC 2016. [DOI: 10.20467/1091-5710-20.4.206] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
24
|
Weiland TJ, Lane H, Jelinek GA, Marck CH, Weil J, Boughey M, Philip J. Managing the advanced cancer patient in the Australian emergency department environment: findings from a national survey of emergency department clinicians. Int J Emerg Med 2015; 8:14. [PMID: 25984244 PMCID: PMC4424226 DOI: 10.1186/s12245-015-0061-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 04/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background Delivery of care to people with advanced cancer in the emergency department (ED) is complicated by competing service demands, workloads and physical design constraints. We explored emergency clinicians’ attitudes to the ED environment when caring for patients who present with advanced cancer, and how these attitudes are affected by access to palliative care services, palliative care education, staff type, ED experience and patient demographic, hospital type and region. Methods We electronically surveyed clinicians from the College of Emergency Nursing Australasia, Australian College of Emergency Nursing and Australasian College for Emergency Medicine working in an Australian ED. Results Respondents were 444 doctors and 237 nurses. They reported overcrowding, noise, lack of time and privacy as barriers to care. Most (93.3%) agreed/strongly agreed that the dying patient should be allocated private space in ED. 73.6% (451) felt unable to provide a desired level of care to advanced cancer patients in ED. Clinician attitudes were affected by staff type, experience, ED demographic and hospital type, but not education in palliative care. Conclusions ED environments place pressure on clinicians delivering care to people with advanced cancer. Integrating palliative care services in ED and redesigning EDs to better match its multifaceted functions should be considered.
Collapse
Affiliation(s)
- Tracey J Weiland
- Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy 3065 Australia ; Department of Medicine, The University of Melbourne, Parkville, 3052 Australia
| | - Heather Lane
- Centre for Palliative Care, The University of Melbourne (St Vincent's Hospital), Fitzroy, 3065 Australia ; St Vincent's Hospital Melbourne, Fitzroy, 3065 Australia
| | - George A Jelinek
- Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy 3065 Australia ; Department of Medicine, The University of Melbourne, Parkville, 3052 Australia
| | - Claudia H Marck
- Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy 3065 Australia ; Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jennifer Weil
- St Vincent's Hospital Melbourne, Fitzroy, 3065 Australia
| | - Mark Boughey
- Centre for Palliative Care, The University of Melbourne (St Vincent's Hospital), Fitzroy, 3065 Australia ; St Vincent's Hospital Melbourne, Fitzroy, 3065 Australia
| | - Jennifer Philip
- Centre for Palliative Care, The University of Melbourne (St Vincent's Hospital), Fitzroy, 3065 Australia ; St Vincent's Hospital Melbourne, Fitzroy, 3065 Australia
| |
Collapse
|
25
|
Weil J, Weiland TJ, Lane H, Jelinek GA, Boughey M, Marck CH, Philip J. What's in a name? A qualitative exploration of what is understood by "palliative care" in the emergency department. Palliat Med 2015; 29:293-301. [PMID: 25634627 DOI: 10.1177/0269216314560801] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The understanding of what palliative care is, and which patients may benefit from palliative care, has important implications for optimal patient care in all areas of health provision. AIM To explore the understanding of palliative care by healthcare professionals caring for patients with advanced cancer attending emergency departments. DESIGN Qualitative study, with two phases: the first, a series of focus groups with healthcare professionals from various disciplines and settings caring for patients with advanced cancer presenting to emergency departments; the second, semi-structured telephone interviews with emergency healthcare professionals across Australian States and Territories, including outside metropolitan centers. The data were audio-recorded and transcribed, with analysis undertaken using a qualitative thematic analysis. SETTING/PARTICIPANTS Saturation of themes was reached after 8 focus groups (22 emergency nurses, 21 emergency physicians, 6 oncologists, 6 hospital palliative care clinicians, and 28 community palliative care clinicians) and 11 telephone interviews (8 emergency physicians and 3 emergency nurses), a total of 94 participants. RESULTS The overarching theme was that healthcare professionals held contradictory understandings of palliative care and its application in the emergency department; subthemes highlighted these inconsistencies when the term "palliative" is used, in understandings of and engagement with palliative care services and in perceptions about the practical utility of palliative care. CONCLUSION There are entrenched contradictions and tensions surrounding the term "palliative care"; confronting these is likely to require more than re-branding, and will promote better care for this vulnerable patient group in the emergency department.
Collapse
Affiliation(s)
- Jennifer Weil
- Centre for Palliative Care, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - Tracey J Weiland
- Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Heather Lane
- Centre for Palliative Care, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - George A Jelinek
- Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Mark Boughey
- Centre for Palliative Care, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| | - Claudia H Marck
- Emergency Practice Innovation Centre, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Jennifer Philip
- Centre for Palliative Care, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
26
|
Jelinek GA, Marck CH, Weil J, Lane H, Philip J, Boughey M, Weiland TJ. Skills, expertise and role of Australian emergency clinicians in caring for people with advanced cancer. BMJ Support Palliat Care 2015; 7:81-87. [DOI: 10.1136/bmjspcare-2014-000671] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 09/03/2014] [Accepted: 12/18/2014] [Indexed: 11/03/2022]
|
27
|
Marck CH, Weil J, Lane H, Weiland TJ, Philip J, Boughey M, Jelinek GA. Care of the dying cancer patient in the emergency department: findings from a National survey of Australian emergency department clinicians. Intern Med J 2014; 44:362-8. [DOI: 10.1111/imj.12379] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 02/10/2014] [Indexed: 11/29/2022]
Affiliation(s)
- C. H. Marck
- Emergency Practice Innovation Centre (EPIcentre); St Vincent's Hospital Melbourne; Melbourne Victoria Australia
| | - J. Weil
- Department of Palliative Care; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Centre for Palliative Care; The University of Melbourne (St Vincent's Hospital); Melbourne Victoria Australia
| | - H. Lane
- Department of Palliative Care; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Centre for Palliative Care; The University of Melbourne (St Vincent's Hospital); Melbourne Victoria Australia
| | - T. J. Weiland
- Emergency Practice Innovation Centre (EPIcentre); St Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne (St Vincent's Hospital); Melbourne Victoria Australia
| | - J. Philip
- Department of Palliative Care; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Centre for Palliative Care; The University of Melbourne (St Vincent's Hospital); Melbourne Victoria Australia
| | - M. Boughey
- Department of Palliative Care; St Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Centre for Palliative Care; The University of Melbourne (St Vincent's Hospital); Melbourne Victoria Australia
| | - G. A. Jelinek
- Emergency Practice Innovation Centre (EPIcentre); St Vincent's Hospital Melbourne; Melbourne Victoria Australia
- Department of Medicine; The University of Melbourne (St Vincent's Hospital); Melbourne Victoria Australia
| |
Collapse
|
28
|
Ouchi K, Wu M, Medairos R, Grudzen CR, Balsells H, Marcus D, Whitson M, Ahmad D, Duprey K, Mancherje N, Bloch H, Jaffrey F, Liberman T. Initiating Palliative Care Consults for Advanced Dementia Patients in the Emergency Department. J Palliat Med 2014; 17:346-50. [DOI: 10.1089/jpm.2013.0285] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kei Ouchi
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Mark Wu
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Robert Medairos
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Corita R. Grudzen
- Department of Emergency Medicine and the Brookdale Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York
| | - Herberth Balsells
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - David Marcus
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Micah Whitson
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Danish Ahmad
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Kael Duprey
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Noel Mancherje
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Helen Bloch
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Fatima Jaffrey
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| | - Tara Liberman
- Department of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, New York
| |
Collapse
|
29
|
Brulotte CA, Lang ES. Acute exacerbations of chronic obstructive pulmonary disease in the emergency department. Emerg Med Clin North Am 2012; 30:223-47, vii. [PMID: 22487106 DOI: 10.1016/j.emc.2011.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is a significant cause of morbidity and mortality worldwide. Acute exacerbations of COPD (AECOPDs) are a common presentation to emergency departments and are an important cause of respiratory failure. This article discusses the disease process and diagnosis of COPD and AECOPD. A further in-depth discussion is undertaken of evidence-based treatments, palliation, and disposition of patients who present to emergency departments with AECOPD.
Collapse
Affiliation(s)
- Cory A Brulotte
- Department of Emergency Medicine, Alberta Health Services: Calgary Zone, Foothills Medical Center, 1403 29th Street Northwest, Room C231, Calgary, Alberta, Canada T2N 2T9.
| | | |
Collapse
|