Improvements in end-of-life care needed for emergency departments, study finds

A study recently published online in Annals of Emergency Medicine highlights the need for more training in emergency departments to handle the increasing number of patients admitted for end-of-life care.

“Patients and their families receive a lot of attention and support in the emergency department when there is an unexpected acute medical illness or a sudden, often traumatic, event that results in death,” lead study author Cara Bailey, MD, of the College of Medical and Dental Sciences at University of Birmingham in England, stated in a American College of Emergency Physicians press release. “While the emergency department is not designed for end-of-life care, the reality is that many patients in this category go there for help, sometimes not realizing this is the end. Emergency resources are focused on saving lives, which tends to shortchange the patients who have terminal illnesses.”

Bailey and her colleagues conducted 1,000 hours of observation and interviewed patients with terminal illnesses, their families and health care staff at the Centre for Social Research in Health and Healthcare at the University of Nottingham in England, which also funded the study. The investigators indentified two paths for dying patients: the spectacular path for those who received intensive life-saving treatment and the subtacular path for those who did not.

The investigators found that terminal patients in the subtacular group and their families were less satisfied with their care compared with those expected to live, according to the release. The study revealed that the emergency department staff tended to distance themselves from subtacular patients, in part because emergency care focuses on resuscitation. Many staff members noted that they felt unprepared to care for dying patients due to a lack of resources or training in palliative care.

“Death, dying and bereavement are daily occurrences in the emergency department, but it is a sadly neglected area of research, professional development and practice,” Bailey stated in the release.“With an increasingly aging population, more people are living longer, and slower dying from chronic illness is becoming the norm. The ‘subtacular’ death is becoming more prevalent in our society. Collaborative effort among policymakers, educators and health care professionals is needed to improve how end-of-life care is provided in the emergency department, not only for patients but also for their families.”

Reference:
www.annemergmed.com

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