`Challenges ahead' for end-of-life care at emergency departments

Posted on Friday 3rd December 2010

Research led by a nursing expert at the University of Birmingham suggests that medical professionals need more training to help them to meet the specific demands of older people and people with terminal illnesses increasingly attending hospital emergency departments for end-of-life care.

According to the collaborative research*, which is published online today in Annals of Emergency Medicine, older people visit - or are taken to - emergency departments near the end of life when they need medical help perhaps not realising they are about to die. But because emergency medicine is geared towards saving and preserving life, this can be unhelpful for people suffering from terminal illness who require supportive palliative care.

‘The study highlights the need to focus on end-of-life care issues at the front door of the hospital emergency department. Frequently the individual needs of patients near the end of life are neglected when resuscitation interventions are prioritised’ says Dr Cara Bailey, lead study author and lecturer in nursing and physiotherapy at the University’s School of Health and Population Sciences.

The study was funded by the Centre for Social Research in Health and Healthcare and was carried out at the University of Nottingham, which also funded the work. It included 1,000 hours of observation and interviews with health care staff, people suffering from terminal illnesses and those caring for them.

The results revealed two trajectories of end-of-life care in emergency departments; the spectacular and the subtacular. In a priority-driven environment focused on prolonging life, the care needs of patients in the subtacular trajectory are neglected, Dr Bailey explains. Ultimately, this results in dissatisfaction for staff, and distress and frustration for patients and their relatives.

Dr Bailey states: ‘In an ageing population, it is highly likely that people will access the emergency department for care as death nears. This research highlights the serious challenges ahead to meet the individual needs of patients at the end of life and their relatives. These trajectories can be used to identify the shortfalls in end-of-life care in the ED, and raise serious concerns for policy in regards to staffing, resources and professional development.’

* Trajectories of End-of-Life Care in the Emergency Department.

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For more information please contact Jenni Ameghino, University of Birmingham Press Office. Tel 0121 415 8134.