Volume 196 - Issue 9
“Anywhere to palliative care” — a fast-track pathway from the emergency department to palliative care
Authors: Sonia L Fullerton, David J Kenner and Maria T Tucker
Med J Aust 2012; 196 (9): 566. || doi: 10.5694/mja12.10521
Published online: 21 May 2012
Published online: 21 May 2012
Patients receiving end-of-life care often present to the emergency department (ED). Although such patients may be more appropriately cared for in a palliative care unit (PCU), the ED can represent a critical decision-making point where goals of care are agreed. We piloted a fast-track palliative care pathway in a Melbourne metropolitan health service ...
To the Editor: Patients receiving end-of-life care often present to the emergency department (ED).1,2 Although such patients may be more appropriately cared for in a palliative care unit (PCU), the ED can represent a critical decision-making point where goals of care are agreed.3
We piloted a fast-track palliative care pathway in a Melbourne metropolitan health service between March 2011 and April 2012. The aim was to promote early transfers (day or night) of appropriate patients from three EDs to an offsite inpatient PCU.
A patient-centred protocol defined inclusion and exclusion criteria.4 Selection criteria for transfer included actively dying patients needing end-of-life care, and those with life-limiting conditions requiring short-term symptom management. Phone consultation between senior emergency and palliative care doctors was used in place of a written referral.
During the 13 months of the pilot, 62 patients were transferred to the PCU, compared with none in the previous 6 months. Patients ranged from 41 to 98 years of age (median, 77 years) and were evenly distributed between men and women. Forty-six patients had a malignant condition. The most common aim of referral was end-of-life care (36 patients), while 23 patients were admitted for symptom control, and three for respite or assessment. The most common outcome of the admission was death (36 patients). Twenty patients were discharged home successfully.
The outcome of each transfer was reviewed by a senior clinician, and 56 transfers were judged to be successful. No adverse events were recorded. Three patients were returned to the acute setting for further treatment, and two of the three returned to the PCU. Overall, patients stayed in the PCU for more than 600 bed-days. An estimated 300 acute bed-days were saved, representing a cost saving of at least $170 000.
Many compliments were received from relatives and patients who had previously experienced frequent acute admissions and were aware they had avoided a long stay on an ED trolley receiving unwanted medical treatment. This model has assisted progress towards achieving ED stay targets in our health service and may be easily replicated in other networks.
Competing interests
No relevant disclosures.
Acknowledgements
We thank Associate Professor Debbie Leach, Deputy Director of the Box Hill Emergency Department.
References
- Rosenwax LK, McNamara BA, Murray K, et al. Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care. Med J Aust 2011; 194: 570-573. 0_CHDCGFBI
- Quest TE, Asplin BR, Cairns CB, et al. Research priorities for palliative and end-of-life care in the emergency setting. Acad Emerg Med 2011; 18: e70-e76. 0_i1142869
- Grudzen CR, Stone SC, Morrison RS. The palliative care model for emergency department patients with advanced illness. J Palliat Med 2011; 14: 945-950. 0_i1142871
- Eastern Health. Fast track emergency department to palliative care unit (Wantirna). http://www.easternhealth.org.au/palliative.aspx (accessed May 2012).