End of life care pathways in the Emergency Department and their effects on patient and health service outcomes: An integrative review

Heufel, Melissa; Kourouche, Sarah; Lo, Wing-Shan Angela; Thomas, Benjamin; Hood, Lucy Jane; Curtis, Kate

doi:10.1016/j.ienj.2022.101153

Cited by 6 publications

(4 citation statements)

References 45 publications

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“…Conversely, clinical pictures due to electrolyte disturbances or acute renal failure could be the reason for admission to the ED, but diagnostic investigations could highlight pulmonary thromboembolism that occurred without symptoms. All these clinical conditions require intervention with specialized skills that treat these complex patients in full, integrating specific skills on cancer emergencies with skills on other emergencies and an ED management aimed at improving the quality and safety of the facility and the patient [ 149 , 150 , 151 , 152 , 153 , 154 , 155 , 156 , 157 ].…”

Section: Discussionmentioning

confidence: 99%

“…In particular, two of the most common and distressing symptoms at end of life are pain and dyspnea, often associated with other symptoms, including nausea and vomiting. From this point of view, the role of the emergency physician appears crucial, not only in the treatment of symptoms but also in communicating with patients and families [ 31 , 149 , 150 ].…”

Section: Discussionmentioning

confidence: 99%

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Acute Oncologic Complications: Clinical–Therapeutic Management in Critical Care and Emergency Departments

Gri

Longhitano

Zanza³

et al. 2023

Current Oncology

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Introduction. It is now known that cancer is a major public health problem; on the other hand, it is less known, or rather, often underestimated, that a significant percentage of cancer patients will experience a cancer-related emergency. These conditions, depending on the severity, may require treatment in intensive care or in the emergency departments. In addition, it is not uncommon for a tumor pathology to manifest itself directly, in the first instance, with a related emergency. The emergency unit proves to be a fundamental and central unit in the management of cancer patients. Many cancer cases are diagnosed in the first instance as a result of symptoms that lead the patient’s admittance into the emergency room. Materials and Methods. This narrative review aims to analyze the impact of acute oncological cases in the emergency setting and the role of the emergency physician in their management. A search was conducted over the period January 1981–April 2023 using the main scientific platforms, including PubMed, Scopus, Medline, Embase and Google scholar, and 156 papers were analyzed. Results. To probe into the main oncological emergencies and their management in increasingly overcrowded emergency departments, we analyzed the following acute pathologies: neurological emergencies, metabolic and endocrinological emergencies, vascular emergencies, malignant effusions, neutropenic fever and anemia. Discussion/Conclusions. Our analysis found that a redefinition of the emergency department connected with the treatment of oncology patients is necessary, considering not only the treatment of the oncological disease in the strict sense, but also the comorbidities, the oncological emergencies and the palliative care setting. The need to redesign an emergency department that is able to manage acute oncological cases and end of life appears clear, especially when this turns out to be related to severe effects that cannot be managed at home with integrated home care. In conclusion, a redefinition of the paradigm appears mandatory, such as the integration between the various specialists belonging to oncological medicine and the emergency department. Therefore, our work aims to provide what can be a handbook to detect, diagnose and treat oncological emergencies, hoping for patient management in a multidisciplinary perspective, which could also lead to the regular presence of an oncologist in the emergency room.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Oncologic Complications: Clinical–Therapeutic Management in Critical Care and Emergency Departments

Gri

Longhitano

Zanza³

et al. 2023

Current Oncology

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“…18 Palliative care networks have made significant progress to integrate multidisciplinary teams into their provision of care, including emergency departments (EDs). 19,20 However, internationally, countries lack public policy frameworks that acknowledge the unique role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. 21 Furthermore, the WHO neglects to recognise the role of EMS in key policy documents despite highlighting 'palliative care requires a broad multidisciplinary approach', 22 in addition to 'multisectoral policy and action to address broader determinants of health'.…”

Section: Introductionmentioning

confidence: 99%

Emergency medical services: the next linking asset for public health approaches to palliative care?

2023

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Emergency medical services (EMS) are a unique workforce providing 24/7 emergency care across high-income countries (HICs) and low- and middle-income countries (LMICs). Although traditionally perceived as first responders to traumatic and medical emergencies, EMS scope of practice has evolved to respond to the changing needs of communities, including a growing demand for community-based palliative care. Public health provides a useful framework to conceptualise palliative and end-of-life care in community-based settings. However, countries lack public policy frameworks recognising the role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. This article aims to explore the potential role of EMS in a public health palliative care approach in a critical discussion essay format by (1) discussing the utility of EMS within a public health palliative care approach, (2) identifying the current barriers preventing public health approaches to EMS palliative care provision and (3) outlining a way forward through priorities for future research, policy, education and practice. EMS facilitate equitable access, early provision, expert care and efficacious integration of community-based palliative care. However, numerous structural, cultural and practice barriers exist, appearing ubiquitous across both HICs and LMICs. A Public Health Palliative Care approach to EMS Framework highlights the opportunity for EMS to work as a linking asset to build capacity and capability to support palliative care in place; connect patients to health and community supports; integrate alternative pathways by engaging multidisciplinary teams of care; and reduce avoidable hospital admissions by facilitating home-based deaths. This article articulates a public health approach to EMS palliative and end-of-life care provision and offers a preliminary framework to illustrate the components of a potential implementation and policy strategy.

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“…Clinical audits have long been used in healthcare to review clinical care delivery against pre-determined standards and, to identify areas for improvement ( Burgess, 2011 ; Crabtree et al., 2020 ). A 2021 review identified significant variability in the quality of care delivered for patients at their end of life in hospitals and determined much work is required to improve and streamline these processes ( NHS Benchmarking Network, 2019 ; Royal College of Physicians, 2016 ; Bloomer et al., 2019 ; Whitehead et al., 2018 ; Heufel et al., 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Development of an emergency department end of life care audit tool: A scoping review

Heufel

Kourouche

Curtis

2023

International Journal of Nursing Studies Advances

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End of life care pathways in the Emergency Department and their effects on patient and health service outcomes: An integrative review

Cited by 6 publications

References 45 publications

Acute Oncologic Complications: Clinical–Therapeutic Management in Critical Care and Emergency Departments

Acute Oncologic Complications: Clinical–Therapeutic Management in Critical Care and Emergency Departments

Emergency medical services: the next linking asset for public health approaches to palliative care?

Development of an emergency department end of life care audit tool: A scoping review

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