Community Palliative Care Patients Attending a Regional Emergency Department: A Retrospective Observational Study.

Abstract

Background: Emergency department (ED) presentations are common for people in their last year of life, but the characteristics of these presentations by regional patients known to palliative care services are limited. Objectives: To identify the characteristics and communication that occur when community-based palliative care (CBPC) patients present to the ED. Design: A retrospective, cross-sectional study of CBPC presentations to the ED over 12 months. Setting: Eligible participants were all regional CBPC patients who attended the index Australian ED between June 1, 2022, and May 31, 2023. Measurements: Data acquired included demographics, presentation details, documented communication, and ED discharge information. Results: An overall 235 CBPC patients presented to the index ED at least once (427 presentations), constituting 1.23% of all adult ED presentations. The median age was 75 years (interquartile range 65-82), and 82.6% had a primary diagnosis of cancer. The most common ED discharge diagnoses were symptom-related (78/427, 18.3%) and respiratory disease (77/427, 18%). Most (300/427, 70.3%) were admitted. Communication between ED and palliative care services was documented in 18.9% of presentations (81/427). Communication was more likely in patients who were admitted (88.9% vs. 11.1%), in work hours (55.6% vs. 44.4%), or in those with a cancer diagnosis (93.8% vs. 6.2%). Conclusion: CBPC patients presented to the ED with a high admission rate, which may indicate appropriate ED presentations. Coordinated care through communication was evident in only a minority of cases. Further studies to explore the complex palliative care needs of patients presenting to the ED and barriers to integrated care between services are vital to providing optimal care.