Implementation of the protocol can effectively shorten the door-to-antibiotic time to meet the international standard of care in neutropenic sepsis patients. The compliance rate was also high. We proved that effective implementation of the protocol is feasible in a busy emergency department through excellent teamwork between nurses, pharmacists, and emergency physicians.

Background Due to the ageing population in Hong Kong, the importance and need of palliative care and end-of-life (EOL) care are coming under the spotlight. The objectives of this study were to evaluate the attitudes of emergency doctors in providing palliative and EOL care in Hong Kong, and to investigate the educational needs of emergency doctors in these areas. Methods A questionnaire was used to study the attitudes of ED doctors of six different hospitals in Hong Kong. The questionnaire recorded the attitudes of the doctors towards the role of palliative and EOL care in EDs, the specific obstacles faced, their comfort level and further educational needs in providing such care. The attitudes of emergency doctors of EDs with EOL care services were compared with those of EDs without such services. Results In total, 145 emergency doctors completed the questionnaire, of which 60 respondents were from EDs with EOL care services. A significant number of participants recognized that the management of the dying process was essential in ED. Providing palliative and EOL care is also accepted as an important competence and responsibility, but the role and priority of palliative and EOL care in ED are uncertain. Lack of time and access to palliative care specialists/ teams were the major barriers. Doctors from EDs with EOL care services are more comfortable in providing such care and discuss it with patients and their relatives. Further educational needs were identified, including the management of physical complaints, communication skills, and EOL care ethics. Conclusions The study identified obstacles in promoting palliative and EOL care in the EDs Hong Kong. With the combination of elements of routine ED practice and a basic palliative medicine skill set, it would promote the development of palliative and EOL care in Emergency Medicine in the future.

Background: With the aging population in Hong Kong, the importance and need of palliative care and end-of-life (EOL) care are brought into the spotlight. The Accident and Emergency Department (AED) is often the first medical contact for the public. The objectives of this study were to evaluate the attitude of emergency doctors in providing palliative and EOL cares in Hong Kong, and to investigate the education needs for emergency doctors in these areas.Methods: A questionnaire study was conducted involving emergency doctors from 6 AEDs in Hong Kong. The questionnaires covered the attitudes of emergency doctors towards the palliative and EOL cares in terms of the role of palliative and EOL care in AED, the specific obstacles in providing such cares, their comfort level with the cares and further education needs The attitudes of emergency doctors from the AEDs with EOL care service were compared with those from the AEDs without such services. Results: One hundred and forty-five emergency doctors completed the questionnaires, in which 60 respondents from the AEDs with EOL care service. Significant proportions from both groups recognized that palliative and EOL cares were an important competence for them, but its role and priority in emergency care were uncertain. Lack of time and access to palliative care specialists/ teams were the major barriers. Participants from AEDs with EOL care service were more comfortable to provide the care and discuss it with patients and relatives. Further education needs identified including management of physical complaints, communication skills and EOL care ethics.Conclusions: The study identified obstacles in promoting palliative and EOL cares in the AEDs in Hong Kong. Education on the communication skills and ethical issues were necessary as well. With the combination of elements of routine AED practice and the basic palliative medicine skill set, it would promote the development of this emerging field in Emergency Medicine in the future.

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