Photo Credit: Pornpak Khunatorn

The following is a summary of “Palliative care patient emergency department visits at tertiary university-based emergency department in Ireland,” published in the April 2023 issue of Emergency Medicine by Nordt, et al.

Palliative care patients often seek emergency department (ED) services due to acute illness, pain, altered mental status, and therapy complications. However, many of these visits involve less severe conditions, such as dyspnea, constipation, or fear as patients approach the end of life, which may be better managed outside the ED. For a study, researchers sought to determine the frequency of presenting complaints, primary diagnosis, triage acuity, and need for admission in palliative care patients in an Irish tertiary-care university hospital emergency department.

The retrospective observational study was conducted at a single center in Dublin, Ireland. Palliative care patients presenting to the ED were identified using the palliative care database and cross-referenced with the ED electronic patient record system database. The primary objective was to identify potential areas to minimize ED visits and improve patient care and quality of life by elucidating reasons for visits. The outcome measures included presenting complaints, primary diagnoses, triage severity score, admission, discharge, and death in the hospital. Descriptive statistics were used for statistical analysis.

The study included 499 ED visits, 245 (49%) males and 254 (51%) females, and a mean age of 69.3 years. The majority of patients, 285 (57.1%), self-referred to the ED, while general practitioners and skilled nursing facility referrals accounted for 72 (14.4%) and 39 (7.8%) of the referrals, respectively. The primary diagnoses were various cancers, chronic obstructive pulmonary disease, congestive heart failure, and dementia. The main reasons for visits were dyspnea, pain, falls, trauma, fever, and altered mental status. Of the total visits, 289 patients (58%) had an emergency severity index (ESI) score of 1 or 2, indicating a higher level of understanding. Among the patients, 358 (71.7%) were admitted, 141 (28.3%) were discharged home, and 64 (12.8%) admitted patients died during their hospital stay.

Palliative care patients frequently use ED services. Although many of these patients presented with higher acuity triage scores, 42% had lower ESI scores and could be managed outside of the ED. The findings suggested the need for developing mechanisms to provide urgent evaluations for these patients in their homes or facilities, reducing the need for ED evaluation.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000402