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end of Life in emergency department

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https://www.readbyqxmd.com/read/28631517/what-factors-influence-emergency-department-visits-by-patients-with-cancer-at-the-end-of-life-analysis-of-a-124-030-patient-cohort
#1
Lesley A Henson, Irene J Higginson, Wei Gao
BACKGROUND: Emergency department visits towards the end of life by patients with cancer are increasing over time. This is despite evidence of an association with poor patient and caregiver outcomes and most patients preferring home-based care. AIM: To identify socio-demographic and clinical factors associated with end-of-life emergency department visits and determine the relationship between patients' prior emergency department use and risk of multiple (⩾2) visits in the last month of life...
June 1, 2017: Palliative Medicine
https://www.readbyqxmd.com/read/28620978/comparison-of-healthcare-utilization-and-life-sustaining-interventions-between-elderly-patients-with-dementia-and-those-with-cancer-near-the-end-of-life-a-nationwide-population-based-study-in-taiwan
#2
Yu-Han Chen, Chung-Han Ho, Chien-Cheng Huang, Ya-Wen Hsu, Yueh-Chun Chen, Ping-Jen Chen, Guan-Ting Chen, Jhi-Joung Wang
AIM: Little is known about the pattern of healthcare services for end-of-life patients with dementia (PwD) in East Asia. We compared this pattern between PwD and cancer patients in their last year of life in Taiwan. METHODS: Taiwan's National Health Insurance Research Database was applied for this case-control analysis. The records of patients who had dementia and died between 2002 and 2011 were reviewed. The control group was decedents with cancer. The utilization of hospitalization, emergency department visits and life-sustaining interventions during the last year of life between the two groups were compared...
June 16, 2017: Geriatrics & Gerontology International
https://www.readbyqxmd.com/read/28600919/group-a-streptococci-infection-a-systematic-clinical-review-exemplified-by-cases-from-an-obstetric-department
#3
REVIEW
Line Winther Gustafson, Jan Blaakær, Rikke Bek Helmig
Group A streptococci infection has re-emerged since the 1980s and onward, despite the awareness of the etiology and the use of penicillin. It now accounts for more than 75,000 deaths worldwide every year. Postpartum women have a 20-fold increased incidence of group A streptococci disease compared to non-pregnant women. This review focuses on the epidemiology, pathophysiology, clinical presentation, prevention and treatment of group A streptococcal infection in pregnancy. SEARCH STRATEGY: We searched the following electronic databases from 1980-March 2016: PubMed-Medline, Embase, SveMed+, Bibliotek...
June 1, 2017: European Journal of Obstetrics, Gynecology, and Reproductive Biology
https://www.readbyqxmd.com/read/28589462/discharge-or-admit-emergency-department-management-of-incidental-pulmonary-embolism-in-patients-with-cancer-a-retrospective-study
#4
Srinivas R Banala, Sai-Ching Jim Yeung, Terry W Rice, Cielito C Reyes-Gibby, Carol C Wu, Knox H Todd, W Frank Peacock, Kumar Alagappan
BACKGROUND: Hospitalization and early anticoagulation therapy remain standard care for patients who present to the emergency department (ED) with pulmonary embolism (PE). For PEs discovered incidentally, however, optimal therapeutic strategies are less clear-and all the more so when the patient has cancer, which is associated with a hypercoagulable state that exacerbates the threat of PE. METHODS: We conducted a retrospective review of a historical cohort of patients with cancer and incidental PE who were referred for assessment to the ED in an institution whose standard of care is outpatient treatment of selected patients and use of low-molecular-weight heparin for anticoagulation...
December 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28499745/distress-in-caregivers-accompanying-patients-to-an-emergency-department-a-scoping-review
#5
Thom Ringer, Daniel Moller, Adam Mutsaers
BACKGROUND: Despite substantial research interest in caregiver distress in the emergency department (ED), no recent review of the literature exists. OBJECTIVE: Our aims were to map primary research on caregiver distress in the ED, synthesize key concepts underpinning the literature, identify gaps, and provide guidance for future work. METHODS: We used a five-stage scoping review with tandem screening and data extraction. RESULTS: Of 2121 records, 29 studies were included...
May 9, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28495487/effect-of-psychiatric-illness-on-acute-care-utilization-at-end-of-life-from-serious-medical-illness
#6
Kyle Lavin, Dimitry S Davydow, Lois Downey, Ruth A Engelberg, Ben Dunlap, James Sibley, William B Lober, Kelson Okimoto, Nita Khandelwal, Elizabeth T Loggers, Joan M Teno, J Randall Curtis
CONTEXT: Little is known about psychiatric illness and utilization of end-of-life care. OBJECTIVES: We hypothesized that pre-existing psychiatric illness would increase hospital utilization at end-of-life among patients with chronic medical illness due to increased severity of illness and care fragmentation. METHODS: We reviewed electronic health records to identify decedents with one or more of eight chronic medical conditions based on International Classification of Diseases (ICD)-9 codes...
May 8, 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/28494680/end-of-life-care-in-emergency-departments-a-review-of-the-literature
#7
Kayla Gloss
Providing end of life care (EOLC) in emergency departments (EDs) is challenging because of minimal resources, lack of staff education and outdated models of care. Dynamic, chaotic environments like EDs require systematic, clear and concise principles and goals for patient care. Death in EDs is inevitable, therefore staff should be equipped to provide optimal care to this vulnerable patient group. This article reviews the literature on the barriers to providing EOLC in EDs, and makes recommendations for clinical practice and further research...
May 12, 2017: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
https://www.readbyqxmd.com/read/28489813/implementing-a-novel-model-for-hospice-and-palliative-care-in-the-emergency-department-an-experience-from-a-tertiary-medical-center-in-taiwan
#8
Tzu-Chieh Weng, Ya-Chun Yang, Ping-Jen Chen, Wen-Fu Kuo, Wei-Lin Wang, Ya-Ting Ke, Chien-Chin Hsu, Kao-Chang Lin, Chien-Cheng Huang, Hung-Jung Lin
Hospice and palliative care has been recognized as an essential part of emergency medicine; however, there is no consensus on the optimal model for the delivery of hospice and palliative care in the emergency department (ED). Therefore, we conducted a novel implementation in a tertiary medical center in Taiwan. In the preintervention period, we recruited a specialist for hospice and palliative medicine in the ED to lead our intervention. In the early stage of the intervention, starting on July 1, 2014, we encouraged and funded ED physicians and nurses to receive training for hospice and palliative medicine and residents of emergency medicine to rotate to the hospice ward...
May 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28476296/rural-emergency-nurses-suggestions-for-improving-end-of-life-care
#9
Renea L Beckstrand, Kelly E Smith, Karlen E Beth Luthy, Janelle L B Macintosh
Many patient visits to emergency departments result in the patient dying or being pronounced dead on arrival. The numbers of deaths in emergency departments are likely to increase as a significant portion of the U.S. population ages. Consequently, emergency nurses face many obstacles to providing quality end-of-life (EOL) care when death occurs. The purpose of this study was to identify suggestions that emergency nurses have to improve EOL care, specifically in rural emergency departments. METHODS: A 57-item questionnaire was sent to 53 rural hospitals in 4 states in the Intermountain West, plus Alaska...
May 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28472598/supportive-cardiology-moving-palliative-care-upstream-for-patients-living-with-advanced-heart-failure
#10
Warren Harris Lewin, Wendy Cheung, A Nina Horvath, Shana Haberman, Archna Patel, Dorothy Sullivan
Heart failure (HF) affects ∼600,000 Canadians and is a chronic, life-limiting illness marked by exacerbations of distressing symptoms requiring acute medical management, typically sought in Canada's emergency departments. HF often has an unpredictable illness trajectory and is a chronic terminal illness with a poor prognosis. Patients living with advanced HF have difficulty in accessing palliative care (PC) supports, which can result in unnecessary suffering as their HF progresses and they near end of life (EOL)...
May 4, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28437201/the-impact-of-community-based-palliative-care-on-utilization-and-cost-of-acute-care-hospital-services-in-the-last-year-of-life
#11
David Youens, Rachael Moorin
BACKGROUND: Community-based palliative care may potentially benefit patients by offering their preferred care at the end of life and benefit systems by reducing hospital use. OBJECTIVE: To compare place of death and acute care hospital use in the last year of life between cancer decedents who did and did not access a community-based palliative care service (PCS). DESIGN: Retrospective observational cohort study using linked individual administrative records from cancer registry, hospital, emergency department (ED), mortality, and PCS databases...
February 16, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28401622/predicting-mortality-in-the-emergency-department-external-validation-and-derivation-of-a-clinical-prediction-tool
#12
Rajat N Moman, Caitlin E Loprinzi Brauer, Katherine M Kelsey, Rachel D Havyer, Christine M Lohse, M Fernanda Bellolio
BACKGROUND: The Choosing Wisely campaign has called for better engagement of palliative and hospice care services for patients in the emergency department (ED). PREDICT is a clinical prediction tool that was derived in an Australian ED cohort. It assesses a patient's risk of mortality at 1 year to select those who would benefit from advanced care planning. Such goals-of-care discussion can improve patients' ability to communicate what they want out of their healthcare and, in cases of end of life, potentially reduce the number of futile interventions...
April 12, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28385298/understanding-advance-care-documents-what-the-nurse-advocate-needs-to-know
#13
Erika Kellogg
The emergency department is a critical care area for those with immediate health care needs, and death is not an uncommon outcome. The discussion regarding end-of-life care is often a subject nurses feel uncomfortable or unprepared to address. Additionally, nurses often encounter obstacles when providing end-of-life care in the emergency department environment. It is vital that emergency nurses are educated about the many aspects of end-of-life care to feel better prepared to address the topic which will ultimately improve patient care...
April 3, 2017: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
https://www.readbyqxmd.com/read/28353509/innovative-urgent-care-for-the-palliative-patient-at-home
#14
Carmel L Montgomery, Charlotte Pooler, Julia E Arsenault, Colleen Berean, Robert Sharman, Cheryl L Cameron, Ingrid de Kock
Palliative and end-of-life patients in their homes are at risk of developing symptom crises requiring urgent care. The usual care for these patients involves transport to an Emergency Department (ED) despite the preference of most palliative patients to stay home. The objective of this initiative was to develop an innovative strategy to provide collaborative care in the home to alleviate symptoms and avoid transport. A partnership was created among Emergency Medical Services and Community Care staff, physicians, and leaders to enable patients to stay at home with existing resources during symptom crisis...
April 2017: Home Healthcare Now
https://www.readbyqxmd.com/read/28333569/are-preferences-for-aggressive-medical-treatment-associated-with-healthcare-utilization-in-the-very-old
#15
Steven M Albert, June R Lunney, Lei Ye, Robert Boudreau, Diane Ives, Suzanne Satterfield, Cameron M Kaplan, Teresa Waters, Hilsa N Ayonayon, Susan M Rubin, Anne B Newman, Tamara Harris
OBJECTIVES: To examine the relationship between end-of-life (EOL) treatment preferences and recent hospitalization or emergency department (ED) care in the very old. DESIGN: Quarterly telephone follow-up of participants in the EOL in the Very Old cohort. SETTING: The EOL in the Very Old Age cohort drew from 1403 participants in the Health, Aging, and Body Composition (Health ABC) study who were alive in year 15 of follow-up. 87.5% (n = 1227) were successfully recontacted and enrolled...
March 23, 2017: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/28264944/innovative-oncology-care-models-improve-end-of-life-quality-reduce-utilization-and-spending
#16
Erin Murphy Colligan, Erin Ewald, Sarah Ruiz, Michelle Spafford, Caitlin Cross-Barnet, Shriram Parashuram
Three models that received Health Care Innovation Awards from the Centers for Medicare and Medicaid Services (CMS) aimed to reduce the cost and use of health care services and improve the quality of care for Medicare beneficiaries with cancer. Each emphasized a different principle: the oncology medical home, patient navigation, or palliative care. Comparing participants in each model who died during the study period to matched comparators, we found that the oncology medical home and patient navigation models were associated with decreased costs in the last ninety days of life ($3,346 and $5,824 per person, respectively) and fewer hospitalizations in the last thirty days of life (fifty-seven and forty per 1,000 people, respectively)...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28225375/impact-of-a-child-life-and-music-therapy-procedural-support-intervention-on-parental-perception-of-their-child-s-distress-during-intravenous-placement
#17
Gabriela S Ortiz, Todd OʼConnor, Jessa Carey, Adam Vella, Audrey Paul, Diane Rode, Alan Weinberg
OBJECTIVES: Child life specialists and music therapists have a unique and integral role in providing psychosocial care to pediatric patients and families. These professionals are trained to provide clinical interventions that support coping and adjustment and reduce the risk of psychological trauma related to hospital visits and health care encounters. The researchers devised a multimodal approach using a combined child life and music therapy intervention to address procedure-related distress in patients receiving intravenous (IV) placement in the pediatric emergency department...
February 21, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28214236/are-hospital-ed-transfers-less-likely-among-nursing-home-residents-with-do-not-hospitalize-orders
#18
Taeko Nakashima, Yuchi Young, Wan-Hsiang Hsu
OBJECTIVES: This study aims to examine whether an advance directive "Do Not Hospitalize" (DNH) would be effective in reducing hospital/emergency department (ED) transfers. Similar effects in residents with dementia were also examined. DESIGN: Cross-sectional study. SETTING/SUBJECTS: New York State (NYS) nursing home residents (n = 43,024). MEASUREMENTS AND ANALYSIS: The Minimum Data Set 2.0 was used to address the study aims...
May 1, 2017: Journal of the American Medical Directors Association
https://www.readbyqxmd.com/read/28169049/the-association-of-community-based-palliative-care-with-reduced-emergency-department-visits-in-the-last-year-of-life-varies-by-patient-factors
#19
Katrina Spilsbury, Lorna Rosenwax, Glenn Arendts, James B Semmens
STUDY OBJECTIVE: Palliative care has been shown to reduce end-of-life emergency department (ED) use. Our objective was to determine how the association of community-based palliative care with reduced ED visits in the last year of life varied by patient factors. METHODS: This was a retrospective cohort study of 11,875 decedents who died with neoplasms, heart failure, renal failure, chronic obstructive pulmonary disease, or liver failure in Western Australia in 2009 to 2010...
April 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28152860/using-information-technology-to-power-an-integrated-community-based-oncology-palliative-care-model
#20
Andrew Allan Hertler, Lianne Matthews, RaeLynn Carr
166 Background: There is a need to improve palliative care program access for patients with cancer. The identification of candidates for palliative care at the point of diagnose can improve care and reduce costs. This pilot program was launched in July 2015 by four stakeholders: Health plan; Regional palliative care provider; Community oncology practice; and Oncology quality management provider. METHODS: Objectives are to increase patient satisfaction, reduce unnecessary utilization and costs...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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