End-of-life care among terminally ill patients in the emergency department: a best practice implementation project.

Introduction: The increasing number of older adults visiting emergency departments (EDs) near the end of life highlights the need for palliative and end-of-life care in this setting, despite the ED's focus on acute care.

Aim: This study implemented evidence-based end-of-life care for terminally ill adult patients in the ED in a medical center in Shanghai, China.

Methods: This project followed JBI Evidence Implementation Framework. A baseline audit was conducted to measure current practices against best practice recommendations. Barriers to evidence-based practices were identified, improvement strategies were implemented, and a follow-up audit was conducted to determine changes in compliance.

Results: The results showed significant improvement in adherence to best practice recommendations. For Criterion 1 (staff training), compliance rose from 77.5% to 100% and knowledge scores increased from 9.68 ± 1.945 to 12.30 ± 2.239 (p < 0.001). For Criterion 2 (patients screened and/or assessed for palliative care needs), compliance increased from 50% to 100%. For Criterion 3 (ED protocol for end-of-life care), compliance rose from 0% to 100%. For Criterion 4 (palliative or end-of-life patients transitioned to the appropriate service), compliance increased from 0% to 30%. For Criterion 5 (strategies promoting a suitable environment), compliance increased from 70% to 90%.

Conclusions: This project resulted in positive changes, including the establishment of a formal end-of-life care protocol. Nursing team support and the range of end-of-life care interventions also improved. However, collaboration and referrals between hospitals and hospices remain challenging. Further audits are needed to assess improvements in care for end-of-life patients.

Spanish abstract: http://links.lww.com/IJEBH/A395.