Emergency medicine and futile care: Taking the road less travelled

O’Connor, Allan; Winch, Sarah; Lukin, Bill

doi:10.1111/j.1742-6723.2011.01435.x

Cited by 32 publications

(38 citation statements)

References 21 publications

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“…O'Connor et al indicated that in EDs, clinicians often play the role of commencing measures which might be judged to be futile in retrospect, and they argue that the ED environment could be an ideal place for difficult conversations, and difficult decisions regarding withholding of treatment [31]. They also indicated that treatment uncertainty is difficult to measure as it is usually the result of attempting to reach a consensus.…”

Section: Resultsmentioning

confidence: 99%

“…They also indicated that treatment uncertainty is difficult to measure as it is usually the result of attempting to reach a consensus. Medical futility has been defined both quantitatively by the probability of the success of a treatment and qualitatively by the perceived value in terms of quality of life [31]. …”

Section: Resultsmentioning

confidence: 99%

“…Reasons for these actions have been associated with miscommunications between doctors and patients; carers and patients, and between health care staff, and lack of information or cultural factors [29, 31, 39, 94, 96, 97]. …”

Section: Resultsmentioning

confidence: 99%

“…In a six-month follow-up study, the reliability of prognosis had a low sensitivity of 35–37% suggesting that only one third of people with poor prognosis were likely to die. In addition, they had a very high specificity of 99% and positive predictive values of 96%, suggesting that most people expected to live survived (only 1% die when they were expected to live) [29, 31, 96, 102]. …”

Section: Resultsmentioning

confidence: 99%

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A Literature Review on Care at the End-of-Life in the Emergency Department

Forero

McDonnell

Gallego

et al. 2012

Emergency Medicine International

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The hospitalisation and management of patients at the end-of-life by emergency medical services is presenting a challenge to our society as the majority of people approaching death explicitly state that they want to die at home and the transition from acute care to palliation is difficult. In addition, the escalating costs of providing care at the end-of-life in acute hospitals are unsustainable. Hospitals in general and emergency departments in particular cannot always provide the best care for patients approaching end-of-life. The main objectives of this paper are to review the existing literature in order to assess the evidence for managing patients dying in the emergency department, and to identify areas of improvement such as supporting different models of care and evaluating those models with health services research. The paper identified six main areas where there is lack of research and/or suboptimal policy implementation. These include uncertainty of treatment in the emergency department; quality of life issues, costs, ethical and social issues, interaction between ED and other health services, and strategies for out of hospital care. The paper concludes with some areas for policy development and future research.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A Literature Review on Care at the End-of-Life in the Emergency Department

Forero

McDonnell

Gallego

et al. 2012

Emergency Medicine International

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“…Among several similar definitions, for example, the American College of Emergency Physicians (ACEP) defines the specialty of EM as a medical specialty dedicated to the diagnosis and treatment of unforeseen illness or injury. [14][15][16][17][18] According to the World Health Organization (WHO), between 2015 and 2050, the proportion of the world's population over 60 years will double, and by 2050 there will be more than 400 million people aged 80 and older worldwide. Notably, among the elderly population, only 15% of all deaths are due to an acute disease or trauma, whereas 85% are related to chronic diseases.…”

Section: Introductionmentioning

confidence: 99%

Unavoidable deaths in the Italian Emergency Departments. Results of a ten years survey. A mirror of substantial social changes, or a warning for a hospital-system pathology?

Cervellin¹,

Casagranda

Ricci

et al. 2017

Emerg Care J

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Emergency departments (EDs) are increasingly used for patients at the end of life stage of their diseases worldwide, even if they do not have acute and potentially treatable conditions. Moreover, an increasingly shortage of hospital beds, in spite of the well-recognized ageing of the population, has led to a progressive prolongation of the average length of stay (LOS) time in the vast majority of Italians EDs. Therefore, the aim of this study was to describe the trend of ED non-traumatic deaths in 11 Italians EDs, and to correlate these deaths with the medium length of stay in the same EDs. All cases classified as died during ambulance transfer or while in the ED have been retrieved from the hospital database of the 11 participating EDs, from January 1st 2007 to December 31st 2016, with the exclusion of traumatic events. The average LOS in minutes of the seven hospitals that could provide this information was then calculated. A continuously increasing number of ED deaths was observed in the vast majority of participating EDs, showing a nearly 30% increases in the last four years. The average LOS of the vast majority of participating hospitals displayed a significant increase during the observational period. We also found a linear correlation between average LOS and total number of ED deaths in the same seven hospitals. We believe that there is a compelling need to reconsider the end of life trajectories, not only under an economical perspective, but mainly according to a more ethical view.

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