End-of-life management protocol offered within emergency room (EMPOWER): study protocol for a multicentre study

Abstract

BackgroundPatients at their end-of-life (EOL) phase frequently visit the emergency department (ED) due to their symptoms, yet the environment and physicians in ED are not traditionally equipped or trained to provide palliative care. This multicentre study aims to measure the current quality of EOL care in ED to identify gaps, formulate improvements and implement the improved EOL care protocol. We shall also evaluate healthcare resource utilisation and its associated costs.Methods and analysisThis study employs a quasiexperimental interrupted time series design using both qualitative and quantitative methods, involving the EDs of three tertiary hospitals in Singapore, over a period of 3 years. There are five phases in this study: (1) retrospective chart reviews of patients who died within 5 days of ED attendance; (2) pilot phase to validate the CODE questionnaire in the local context; (3) preimplementation phase; (4) focus group discussions (FGDs); and (5) postimplementation phase. In the prospective cohort, patients who are actively dying or have high likelihood of mortality this admission, and whose goal of care is palliation, will be eligible for inclusion. At least 140 patients will be recruited for each preimplementation and postimplementation phase. There will be face-to-face interviews with patients’ family members, review of medical records and self-administered staff survey to evaluate existing knowledge and confidence. The FGDs will involve hospital and community healthcare providers. Data obtained from the retrospective cohort, preimplementation phase and FGDs will be used to guide prospective improvement and protocol changes. Patient, family and staff relevant outcomes from these changes will be measured using time series regression.Ethics and disseminationThe study protocol has been reviewed and ethics approval obtained from the National Healthcare Group Domain Specific Review Board, Singapore. The results from this study will be actively disseminated through manuscript publications and conference presentations.Trial registration numberNCT03906747.

Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea

“…However, environmental constraints make it unreasonable to conduct palliative care consultations with all ED patients. Here, suggested augmentations include screening criteria [ 58 ], training to recognize triggers [ 59 ], EOL management protocols [ 28 ], palliative care training courses [ 60 , 61 ], and short-stay observation units [ 62 ]. ED physicians and palliative care specialists can also work toward a mutual understanding of their respective priorities, expectations, and management flow pressures [ 58 , 63 – 66 ].…”

Perspectives towards End-of-Life Care in the Emergency Department of Tertiary Public Hospitals—A Qualitative Analysis

“…The interview questions were developed through an iterative process, from a literature review [ 18 , 19 , 20 , 21 , 22 ] and research studies previously conducted by the team on end-of-life care in the ED [ 23 , 24 ]. The questions aimed to elicit participants’ perceptions about end-of-life care in the ED, such as positive experiences, challenges, barriers, and suggestions for improvement.…”