Hospital

Acute hospital settings

Intensive Care, Emergency Department

Many deaths in hospital occur in areas where palliative care expertise is not available. [1] This could include areas such as an Intensive Care Unit (ICU) or Emergency Department (ED).

Emergency Departments are more recently focusing on end of life care as palliative care patients are increasingly being seen and treated in these areas. While this is not the optimal place of care or place of death, carers are not always aware of how close the patient is to death or they call an ambulance as they are experiencing difficulty coping or with managing complex symptoms. A survey of ED physicians found that many were comfortable caring for those at the end of life, but that patients would undergo unnecessary treatment. [2] Another study highlighted specific issues for ED staff, for example, lack of knowledge of palliative care strategies, including prognostication, decision making and planning. [3]

Many decisions in the ICU are related to the withdrawing and withholding of treatment, which often involves surrogate decision-making. [4]

In some hospitals, palliative care teams are available for consultation, as they are either on-site or are visiting specialists. In one review palliative care interventions decreased patient length of stay, improved communication (which in turn lowered family distress), decreased procedures and, therefore, shortened the time interval before comfort measures were introduced. [5]
  1. Witkamp FE, van Zuylen L, van der Maas PJ, van Dijk H, van der Rijt CC, van der Heide A. Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: the study protocol of the PalTeC-H project. BMC Health Serv Res. 2013 Mar 25;13:115.
  2. Marck C, Weil J, Lane H, Weiland T, Philip J, Boughey M, et al. Care of the dying cancer patient in the emergency department: findings from a National survey of Australian emergency department clinicians. Intern Med J. 2014 Apr;44(4):362-8.
  3. Forero R, McDonnell G, Gallego B, McCarthy S, Mohsin M, Shanley C, et al. A literature review on care at the End-of-Life in the emergency department. Emerg Med Int. 2012;2012:486516. Epub 2012 Mar 6.
  4. Wiedermann CJ, Lehner GF, Joannidis M. From persistence to palliation: limiting active treatment in the ICU. Curr Opin Crit Care. 2012 Dec;18(6):693-9.
  5. Aslakson R, Cheng J, Vollenweider D, Galusca D, Smith TJ, Pronovost PJ. Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med. 2014 Feb;17(2):219-35.

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Last updated 14 February 2017