P-50

Background and research question

Nurses from a palliative team suspected that several referrals from terminal care recipients to the Emergency Department (ED) of a regional hospital had been avoidable, if proactive care planning had taken place . In this study the characteristics and the referral trajectory of the terminal care recipients who were registered at the ED between 1 March 2015 and 1 January 2016 were described.

Method

This is a retrospective study in which several characteristics have been systematically assessed in electronic medical records. Records were included if: 1) the patient was registered at the ED in the chosen time period and died within three months after the last registration, and 2) had an advanced disease or illness with a short prognosis when registering, so that the risk of death might be could have been identified by doctors.

Results

A total of 395 terminal care recipients (52% male) were registered at the ED. This mainly concerned people with dementia / frailty (33%) and cancer (31%). Main complaints were respiratory complaints (46%), pain (40%) and nutritional problems (28%). Twenty-eight (7%) care recipients were referred back to home, whereas the majority (358 = 90%) was hospitalized. Five care recipients died at the ED and four were referred to a hospice or other hospital. Ultimately, 40% of the terminal care recipients referred to the ED were deceased at the hospital. Nearly 50% of the care recipients were referred to the ED through their own GP, 14%. The palliative team was consulted in almost a quarter of the care recipients.

Conclusion

Especially people with dementia/frailty and cancer are at risk of being referred to the ED in the last three months before death. After referral, the risk of admission and death within the hospital is high. It is striking that the 'own' GP often enters the care recipient himself. The palliative team is not consulted very often.