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Palliative care for patients who died in emergency departments: analysis of a multicentre cross-sectional survey
  1. Myriam Van Tricht,
  2. David Riochet,
  3. Eric Batard,
  4. Arnaud Martinage,
  5. Emmanuel Montassier,
  6. Gilles Potel,
  7. Philippe Le Conte
  1. Institut de Transplantation et de Recherche en Transplantation, d'Urologie, de Néphrologie (ITERT-Uro-Néphro)—INSERM U643, France
  1. Correspondence to Professor Philippe Le Conte, Service des Urgences, Centre Hospitalier Universitaire, Nantes, France; philippe.leconte{at}chu-nantes.fr

Abstract

Objectives A growing number of patients die each year in hospital emergency departments (EDs). Decisions to withhold or to withdraw life-support therapies occur in 80% of patients as described in a multicentre cross-sectional survey including 2420 patients. Palliative care has not been explored in patients dying in this setting. The aim of this study was to assess the incidence of palliative care and to describe this population.

Methods The authors conducted a post-hoc analysis on a cohort of 2420 patients who died in 174 French and Belgian EDs. The authors identified patients who benefited from palliative care and described this population and the palliative care.

Results Palliative therapies were administered to 1373 patients (56.7%). These therapies included administration of analgesics, sedation, mouth care, repositioning for comfort (as appropriate) and provision of emotional support to the patient and his/her relatives. These palliative measures were provided more frequently in the observation unit of the ED (n=908, 66.2%) than in an examination room (n=465, 33.8%). Median time interval between ED admission and death was longer in patients who received palliative care (n=1373) (median, 15 h; first quartile, 6 h; third quartile, 34 h) than in those who did not (n=1047) (median, 4 h; first quartile, 1 h; third quartile, 10 h) (p<10−4).

Conclusions Palliative care is administered to about half of the patients who die in EDs. This is insufficient as the majority of the patients who died in EDs actually died after a decision to withhold or withdraw life-support therapies. End-of-life management must be improved in EDs.

  • Emergency medicine
  • death
  • ethics
  • palliative care
  • aged
  • clinical management
  • death/mortality
  • cardiac arrest

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Footnotes

  • This study was presented at the National Congress of the French Society of Emergency Medicine (Société Française de Médecine d'Urgence) in Paris on 3 June 2010.

  • Funding This study was financed by a grant from the French Programme Hospitalier de Recherche Clinique, French Ministry of Health.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Nantes University Hospital Ethics Committee.

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

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