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Death with dignity in the accident and emergency short stay ward
  1. D K Pedley,
  2. M Johnston
  1. Accident and Emergency Department, Ninewells Hospital and Medical School, Dundee

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    Editor,—Many uses for the accident and emergency (A&E) short stay ward have been proposed, ranging from the management of head injury to the care of self poisoned patients.1, 2 Since the opening of our new facility in November 1998 we have, on nine occasions, admitted patients to a sideroom of our short stay facility for palliative care. We propose that the short stay ward can offer a sensitive and dignified setting for the dying patient. Details of these patients are listed in table 1.

    In all these cases the patient presented to the A&E department either with an emergent disorder or with the acute decompensation of a pre-existing condition.

    In each case consensus was reached between the duty A&E consultant and inpatient specialty team that the patient's death was imminent and active intervention was not appropriate. The patient was then, after discussion with family members admitted to a sideroom of the short stay ward.This use of the short stay ward permits continuity of care by both medical and nursing staff. In addition it obviates the need for repeated intrusive examination and documentation.

    We have found the short stay can offer privacy for patients and relatives permitting the prompt delivery of appropriate palliative care. In our experience this approach was greatly appreciated by patients and their families.

    The importance of palliative care continues to receive attention with the development of many novel approaches in both primary care and hospital medicine.3 We advocate the judicious and sensitive use of the A&E short stay ward for this purpose and propose that it compares favourably with admission to busy medical or surgical admission wards.

    Table 1


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