Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs

PLoS One. 2021 Sep 27;16(9):e0257501. doi: 10.1371/journal.pone.0257501. eCollection 2021.

Abstract

Introduction: This study examined emergency department (ED) presentations of patients with end of life (EOL) conditions and patients having met and unmet palliative care needs were compared.

Methods: Presentations for EOL conditions were prospectively identified and screened for palliative care needs. Descriptive data were reported as proportions, means or medians. Bi-variable analysis for dichotomous and continuous variables were performed by chi-squared and T-tests (p≤0.01), respectively. A multivariable logistic regression model identified factors associated with having unmet palliative needs and reported adjusted odds ratios (aOR) with 95% confidence intervals (CI).

Results: Overall, 663 presentations for EOL conditions were identified; 518 (78%) involved patients with unmet palliative care needs. Presentations by patients with unmet palliative needs were more likely to involve consultations (80% vs. 67%, p = 0.001) and result in hospitalization (69% vs. 51%, p<0.001) compared to patients whose palliative needs were met. Patients with unmet palliative care needs were more likely to have previous ED visits (73% unmet vs. 48% met; p<0.001). While medication, procedures, investigations and imaging ordering were high across all patients with EOL conditions, there were no significant differences between the groups. Consultations with palliative specialists in the ED (6% unmet vs. 1% met) and following discharge (29% unmet vs. 18% met) were similarly uncommon. Patients having two or more EOL conditions (aOR = 2.41; 95% CI: 1.16, 5.00), requiring hospitalization (aOR = 1.93; 95% CI: 1.30, 2.87), and dying during the ED visit (aOR = 2.15; 95% CI: 1.02, 4.53) were strongly associated with having unmet palliative care needs.

Conclusions: Most ED presentations for EOL conditions were made by patients with unmet palliative care needs, who were significantly more likely to require consultation, hospitalization, and to die. Referrals to palliative care services during and after the ED visit were infrequent, indicating important opportunities to promote these services.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Emergency Service, Hospital* / organization & administration
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • Odds Ratio
  • Palliative Care* / statistics & numerical data
  • Physicians / psychology
  • Prospective Studies
  • Referral and Consultation
  • Terminal Care
  • Tertiary Care Centers

Associated data

  • figshare/10.6084/m9.figshare.14454660

Grants and funding

Funding for this review was provided by the Ministry of Alberta Health, Government of Alberta, which provided partial salary support for authors SWK, MGC, MK, and AE. BHR's research is supported by the Canadian Institutes of Health Research (CIHR) through a Scientific Directors Grant (SOP 168483) from the Government of Canada (Ottawa, ON), which provided partial salary support for authors CVR and EHY. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.