Dec. 3, 2010, Washington, DC-- Emergency physicians and nurses require more training to manage the complex needs of growing numbers of patients who come to the emergency department for end-of-life care, according to a study published online today in Annals of Emergency Medicine ("Trajectories of End-of-Life Care in the Emergency Department").
"Patients and their families receive a lot of attention and support in the emergency department when there is an unexpected acute medical illness or a sudden, often traumatic event that results in death," said lead study author Dr. Cara Bailey of the College of Medical and Dental Sciences at the University of Birmingham in Birmingham, England. "While the emergency department is not designed for end-of-life care, the reality is that many patients in this category go there for help, sometimes not realizing this is the end. Emergency resources are focused on saving lives, which tends to shortchange the patients who have terminal illnesses."
The study, conducted at and funded by the Centre for Social Research in Health and Healthcare at the University of Nottingham, England is based on 1,000 hours of observation, plus interviews with health care professionals, patients with terminal illnesses and their relatives. Researchers identified two trajectories for dying patients: the spectacular (applied to those who are candidates for intensive life-preserving treatment) and the subtacular (applied to those who are not).
Terminal patients (on the subtacular trajectory) and their families reported less satisfaction with their care than patients whose death was unexpected. Staff tend to distance themselves from these patients, in part because emergency care is prioritized toward resuscitation. Many report feeling unprepared to care for the dying in the emergency department, either because of a lack of resources or because they receive so little training in palliative care.
"Death, dying and bereavement are daily occurrences in the emergency department, but it is a sadly neglected area of research, professional development and practice," said Dr. Bailey. "With an increasingly aging population, more people are living longer, and slower dying from chronic illness is becoming the norm. The ‘subtacular' death is becoming more prevalent in our society. Collaborative effort among policymakers, educators and health care professionals is needed to improve how end-of-life care is provided in the emergency department, not only for patients but also for their families."
Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, a national medical society. ACEP is committed to advancing emergency care through continuing education, research, and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. For more information visit www.acep.org.
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