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Plea for patients at end of life in overcrowded emergency departments

Author: Petrina Vousden
21 December 2016

The Irish Hospice Foundation (IHF) is urging hospitals to ensure patients nearing end-of-life in emergency departments are identified and fast-tracked to the most appropriate care setting.

The appeal follows figures from the Irish Nurses and Midwives Organisation depicting ongoing emergency department (ED) overcrowding.

On one morning alone this month there were 541 patients admitted to hospital who were on trolleys in emergency departments and wards across the country.

The figures confirm that in the first 11 months of this year almost 85, 800 patients who needed a hospital bed were left on trolleys in EDs or wards because there were no beds available for them.

Marie Lynch – IHF Head of Healthcare Programmes said the reality is with or without Emergency Department  overcrowding some people in emergency departments are at end-of-life.

About one in ten people (12 per cent) who die in hospitals die in the Emergency Department. Four fifths of people who did in hospitals have been admitted through the ED.

Ms Lynch said: “We want people who are at end-of-life to be identified quickly by ED staff and fast-tracked to an appropriate place,” Ms Lynch said.

She said ED staff are the gateway for a lot of people who have end- of- life and palliative care needs and for families who are experiencing loss and grief.

Ms Lynch said: “It’s vital that as well as staff  being trained in emergency medicine that they are also comfortable in addressing and recognising  when a patient may be nearing the end of life  and ensuring those patients are in a care setting where they can have that dignity and respect in their last few days.”

She praised St Vincent’s University Hospital in Dublin for introducing a quality improvement initiative to integrating palliative care in its emergency departments.

As part of the project the patient administration system in the emergency department was modified to flag patients in need of palliative care within the emergency department.

She said she would like to see all emergency departments adopt a similar system and the IHF’s own Hospice Friendly Hospitals Programme to enable staff to bring hospice principles into their work and ensure the dignity of someone as they are approaching end of life as well as responding to the needs of the bereaved.

She said patients at end-of-life could include elderly patients and patients with dementia who have been referred from a nursing home. She said as well as being  fast-tracked to a more appropriate place in the hospital the possibility of fast-tracking them back to their familiar nursing home environment should be explored.




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