ER providers need more palliative training

As the aging population continues to grow, more patients are arriving in hospital emergency rooms seeking palliative--rather than resuscitative--care, a trend that is placing an increasing burden on emergency care providers, according to a study published today in the Annals of Emergency Medicine. Such doctors and nurses tend to be less emotionally supportive toward palliative patients because they aren't necessarily trained in that manner, something that needs to be fixed, the study's authors conclude. 

"The patients and relatives associated with the subtacular trajectory of dying and death are more likely to experience less attention in the ED, which results in a poor experience of care," write the authors, led by Dr. Cara Bailey of the College of Medical and Dental Sciences at the University of Birmingham (England). "Emergency staff need to be able to recognize and acknowledge their role in end-of-life care delivery and clearly define the parameters of their work to manage the emotional impact of end-of-life care to ensure the delivery of excellent care at the end of life for all patients." 

Most ED patients, the authors point out, are considered "spectacular," defined as "candidates for intensive life-preserving treatment," as opposed to the aforementioned "subtacular" patients who oftentimes suffer from chronic illnesses. As such, care providers instinctively distance themselves, considering their job is to treat and move on to the next patient as quickly as possible. 

"Death, dying and bereavement are daily occurrences in the ED, but despite more than 22,000 people dying in EDs annually, it is a sadly neglected area of research, professional development and practice," the authors write. 

The study consisted of 1,000 hours of observation at the Centre for Social Research in Health and Healthcare at the University of Nottingham. Interviews were conducted with both care providers and patients, as well as relatives of the patients. 

To learn more:
- here's the study (.pdf)
- read this supporting press release

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