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How common are palliative care needs among older people who die in the emergency department?
  1. Teresa Beynon1,2,
  2. Barbara Gomes2,
  3. Fliss E M Murtagh2,
  4. Ed Glucksman3,
  5. Andy Parfitt2,
  6. Rachel Burman3,
  7. Polly Edmonds3,
  8. Irene Carey1,
  9. Jeff Keep3,
  10. Irene J Higginson2
  1. 1Guy's and St. Thomas' NHS Foundation Trust, St. Thomas' Hospital, London, UK
  2. 2King's College London, Department of Palliative Care, Policy & Rehabilitation, Weston Education Centre, London, UK
  3. 3King's College Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Teresa Beynon, Department of Palliative Care, St. Thomas' Hospital, Westminster Bridge Road, London SE1 7EH, UK; teresa.beynon{at}gstt.nhs.uk

Abstract

Objective To determine the prevalence and nature of palliative care needs in people aged 65 years or more (65+) who die in emergency departments (EDs).

Methods This was a retrospective analysis of routine hospital data from two EDs in South London. Patients aged 65+ living in the hospitals' catchment area who died in the ED during a 1 year period (2006–2007) were included. Palliative care needs identified by diagnosis and symptoms, and problems likely to benefit from palliative care documented in clinical records 3 months prior to the final ED attendance were extracted.

Results Over 1 year, 102 people aged 65+ died in the ED, frequently following an acute event (n=90). 63.7% presented out of hours. 98/102 were admitted by ambulance, over half (n=59) from home. Half (n=50) had attended the same ED or been admitted to the same hospital in the previous 12 months. Over half (58/102) presented with diagnoses that signalled palliative care need. Of these, 29 had recorded symptoms a week before death and 28 had complex social issues 3 months prior to death. Only eight were known to palliative care services.

Conclusions There is considerable palliative care need among older people who ultimately died in the ED, of whom only a minority were known to palliative care services in this study. Previous ED and hospital admission suggest opportunities for referral and forward planning. More older people in need of palliative care must be identified and managed earlier to avoid future undesired admissions and deaths in hospital.

  • Analgesia/pain control
  • emergency ambulance systems
  • emergency care systems
  • emergency care systems
  • admission aviodance
  • prehospital care

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Footnotes

  • Funding Guy's and St. Thomas' Charity and Kings College Hospital Charity.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the Royal Marsden Ethics Committee (REC number 07/H0801/151).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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