Emergency departments unfit for dying patients, doctors say
A new study reveals that around 90 percent of clinicians believe the country's A&Es are unsuitable for the provision of end-of-life care
Only one in 10 emergency doctors believe the physical environment of A&E is conducive to the provision of end-of-life care, according to a new study.
Critically ill patients arrive at emergency departments across the country frequently, but new research has found that just under a quarter (23 per cent) of clinicians believe appropriate rooms are allocated to dying patients.
Consultant in Emergency Medicine, Dr James Foley, one of the main authors of the study, said emergency departments in Ireland are chronically crowded and overwhelmed with trolleys.
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He added: “Often, it is difficult to find space to assess patients due to this congestion, and when patients present to the Emergency Department who either expectantly or acutely need end-of-life care, this presents a challenge to find a suitable space to provide dignified and comfortable care to patients and their families.
“Many Irish clinicians will have experience of patients dying in resuscitation rooms, with the noise of the chaotic Emergency Department preventing a peaceful and intimate environment for families to say goodbye to their loved one.
“One in 10 respondents felt the ED isn’t suitable to provide adequate end-of-life care, largely down to capacity issues, which impacts all patients.”
The research was based on a survey study of 311 emergency medicine clinicians across 23 of the 29 A&E departments in Ireland. It found there was a “clear desire for further training in all aspects of end-of-life care” among doctors. The researchers said emergency medicine clinician training is predominately focused on treatment to preserve life.
But they said: “It is well recognised that patients present to emergency departments in the last days or hours of their lives, switching the focus of the emergency medicine clinician from life preservation to the provision of comfort and dignity during the dying process.”
The Irish Trainee Emergency Research Network conducted the survey in 2021.
Seven out of 10 agreed that they felt comfortable breaking bad news to patients or families while 65 per cent agreed they would routinely engage families in end-of-life care discussions and decisions for a patient, according to the study in the Emergency Medicine Journal.
Meanwhile, 78 per cent of more experienced clinicians agreed they were confident in supporting family members in decision-making around end-of-life care compared to 43 per cent of junior clinicians.
Some 62 per cent of clinicians who had worked more than a decade discuss religious beliefs with families and patients compared to just 20 per cent of those with less than five years’ experience. The researchers found more experienced clinicians agreed that they were more confident in assessing pain in patients at end-of-life care when compared with clinicians with less than five years of emergency medicine.
“Only 11.6 per cent of respondents agreed that the physical environment is conducive to the provision of end-of-life care and 32.2 per cent of respondents agreed routine debriefing and feedback occurred after a death”, said the study.
“Current staffing and occupancy constraints” mean less than one-third of the respondents agreed patients at end-of-life care have a single room or have a staff member specifically allocated to their care.
“The majority felt the Emergency Department was the wrong place to receive end-of-life care. Improved infrastructure, staffing and educational supports are potential solutions to develop this skillset.”
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