End-of-life care: A retrospective cohort study of older people who died within 48 hours of presentation to the emergency department

Article


Sweeny, Amy, Alsaba, Nemat, Grealish, Laurie, May, Katya, Huang, Ya-Ling, Ranse, Jamie, Denny, Kerina J, Lukin, Bill, Broadbent, Andrew, Burrows, Erin, Ranse, Kristen, Sunny, Linda, Khatri, Meghna and Crilly, Julia. 2024. "End-of-life care: A retrospective cohort study of older people who died within 48 hours of presentation to the emergency department." Emergency Medicine Australasia. 36 (1), pp. 13-23. https://doi.org/10.1111/1742-6723.14331
Article Title

End-of-life care: A retrospective cohort study of older people who died within 48 hours of presentation to the emergency department

ERA Journal ID16047
Article CategoryArticle
AuthorsSweeny, Amy, Alsaba, Nemat, Grealish, Laurie, May, Katya, Huang, Ya-Ling, Ranse, Jamie, Denny, Kerina J, Lukin, Bill, Broadbent, Andrew, Burrows, Erin, Ranse, Kristen, Sunny, Linda, Khatri, Meghna and Crilly, Julia
Journal TitleEmergency Medicine Australasia
Journal Citation36 (1), pp. 13-23
Number of Pages11
Year2024
PublisherJohn Wiley & Sons
Place of PublicationAustralia
ISSN1742-6723
1742-6731
Digital Object Identifier (DOI)https://doi.org/10.1111/1742-6723.14331
Web Address (URL)https://onlinelibrary.wiley.com/doi/10.1111/1742-6723.14331
Abstract

Objectives
To describe the characteristics of, and care provided to, older people who died within 48 h of ED presentation.

Methods
A descriptive retrospective cohort study of people 65 years and older presenting to two EDs in Queensland, Australia, between April 2018 and March 2019. Data from electronic medical records were collected and analysed.

Results
Two hundred and ninety-five older people who died within 48 h of ED presentation were included. Nearly all arrived by ambulance (92%, n = 272) and 36% (n = 106) were from aged care facilities. Three-quarters (75%, n = 222) were triaged into the most urgent triage categories (i.e. Australasian Triage Scale; ATS 1/2). Fewer than half were previously independent with mobility (38%, n = 111) and activities of daily living (43%, n = 128). Sixty-one per cent (n = 181) had a pre-existing healthcare directive. Twenty-two per cent (n = 66) died in ED, most commonly due to pneumonia, intracerebral haemorrhage, cardiac arrest and/or sepsis. Over half had one or more ED visits (52%, n = 154) and/or hospital admissions (52%, n = 152) 6 months prior.

Conclusions
Identification of patients at end-of-life (EoL) is not always straightforward; consider recent reduction in independence and recent ED visits/hospital admissions. System-based strategies that span pre-hospital, ED and in-patient care are recommended to facilitate EoL pathway implementation and care continuity.

Keywordsaged; critical illness; delivery of healthcare; emergency service; palliative car; hospital; terminal care
Contains Sensitive ContentDoes not contain sensitive content
ANZSRC Field of Research 2020420501. Acute care
420316. Palliative care
Byline AffiliationsGold Coast Hospital and Health Service, Australia
Griffith University
Bond University
Southern Cross University
University of Queensland
Royal Brisbane Residential Aged Care Assessment and Referral Service, Australia
Lyell McEwin Hospital, Australia
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