Quality of end-of-life care in the emergency department

摘要

ObjectiveTo assess appropriateness of end-of-life treatments provided to actively dying patients attending the emergency department of a primary care hospital.MethodsRetrospective cohort study of patients who died in the emergency department of a French primary care hospital between January 2014 and January 2017. The deceased were identified through the admissions register. Then, electronic medical records were screened for bio-demographic data, data relative to decisions to withhold or withdraw treatments, to diagnosis and to the care provided. Patients were clustered into two categories, actively dying or non-actively dying, using clinical opinion based on their medical records. Appropriateness of care was appraised following French guidelines.ResultsOne hundred and forty-six deaths were recorded. Actively dying patients mostly suffered from vascular conditions (29.4%). When compared to the overall sample, they were more likely to have decisions to withhold or withdraw treatments (OR?=?5.3 [1.56; 20.7], p-value?=?0.003), to have strong opioids (OR?=?5.32 [2.1; 13.9], p-value <0.0001), hypnotics (OR?=?2.6 [0.95; 8.39], p-value?=?0.05), and scopolamine (OR?=?2.5 [1.1; 6.13], p-value?=?0.03). Moreover, they were less likely to have unbeneficial treatments in terminal conditions, such as resuscitation care (OR?=?0.06 [0.001; 0.52], p?=?0.002) and antibiotics (OR?=?0.42 [0.19; 0.92], p-value?=?0.022). There were no differences in rate of hydration, venous access and use of tracheal aspirations.ConclusionsOverall, actively dying patients were appropriately supported. However, several issues regarding hydration management, drug administration routes, and broncho-pulmonary secretions management remain to be addressed.