[Therapeutic Adequacy in Nine Emergency Departments in Chile: When and How It Is Applied in Emergency Care].

Abstract

Therapeutic Adequacy (TA) in Emergency Departments (EDs) aims to avoid futile medical interventions in terminally ill or critically ill patients, prioritizing their quality of life. This descriptive, cross-sectional, observational study analyzed the criteria used by physicians in high-complexity EDs in Chile to indicate TA, while also assessing their preparedness and ethical perceptions.

Aim: Examine the criteria that physicians in high-complexity Emergency Departments (EDs) in Chile use to determine Therapeutic Adequacy (TA) in terminally ill or critically ill patients, while also assessing their level of preparedness and ethical perceptions regarding these decisions.

Methods: A 14-item closed survey, based on previous studies, was distributed among physicians from 9 high-complexity EDs between February and October 2023. A total of 70 responses were collected.

Results: TA was performed more than once a month by 83% of respondents, with patient functionality (97%), chronic diseases (84%), and age (69%) being the most frequently considered criteria. The most common measures included refraining from resuscitation (97%) and mechanical ventilation (94%). While 65% of participants felt prepared to make these decisions, this figure increased to 85% among emergency specialists. However, 67% reported no formal training in bioethics, and 55% expressed discomfort with withdrawing therapeutic measures.

Conclusions: TA is a frequent practice in EDs, mainly involving decisions not to initiate treatments. Despite this, there is limited formal training in bioethics, and individual decision-making predominates. This highlights the need to enhance bioethics education, foster collaborative decision-making, and implement hospital protocols that involve patients and their families to ensure an ethical, patient-centered approach.