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2163 Enablers and barriers to the provision of end-of-life care in Irish emergency departments. A national survey
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  1. James Foley1,
  2. Etimbuk Umana2,
  3. Jeffrey Mulcaire3,
  4. Saema Saeed4,
  5. Leonard Browne5,
  6. Owen Keane6,
  7. Mary Jane O’ Leary3,
  8. Conor Deasy3
  1. 1North Bristol Trust NHS
  2. 2Mater Misericordiae Hospital
  3. 3Cork University Hospital
  4. 4Tallaght University Hospital
  5. 5University of Limerick
  6. 6Beaumount Hospital

Abstract

Aims and Objectives Patients with End-of-Life (EOL) care needs present to the emergency department (ED) frequently, and at times it can be difficult to provide a high standard of care. Internationally, there is a dearth of literature on the provision of EOL care in EDs and this study aimed to evaluate the enablers and barriers to providing EOL care in Irish EDs.

Method and Design This was a cross-sectional electronic survey study of EM doctors working across 23 of the 29 EDs in the Republic of Ireland. This study was conducted through the Irish Trainee Emergency Research Network (ITERN) over a 6-week period from 27/9/2021 to 8/11/2021. A survey tool adapted from Eager et al and care of the dying evaluation emergency medicine questionnaire was used after multiple iterations with EM and palliative care experts. Domains assessed included Demographic data (9 Q), Communication in EOL Care in the ED (12 Q), EOL Clinical Management in the ED (23 Q), EOL services & resources available in the ED (14 Q).

Results and Conclusion Of 694 potential respondents, 311 (44.8%) had completed surveys. The majority (62%) were between 25 – 35 years of age with 60% having < 5 years’ experience in EM. 55.8% were male. Clinicians with >10 years’ experience in EM had higher agreement regarding comfort discussing EOL with patients and families than those with <5 years’ experience (78% vs 39%) (p<0.001). Regarding clinical management, 31.9% were comfortable commencing subcutaneous medications. 23.5% agreed that appropriate rooms are allocated for EOL patients, with just 11.6% agreeing that the physical environment is conducive to the provision of EOL care. Figure 1 shows that respondents agreed on the need for EOL training.

This study describes the barriers and enablers to the delivery of EOL care in Irish EDs. Systematically addressing these through education, training and quality improvement could lead to better EOL care.

Abstract 2163 Figure 1

Further EOL training and education responses by question

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