ABSTRACT
BackgroundDeaths in the Emergency Department (ED) are frequently unavoidable, resulting from unexpected emergency situations. However, data suggests that patients in the last year of life are more likely to be admitted to hospital. These patients also die in the ED, often against their prior expressed wishes. During the COVID pandemic, with visiting restrictions meaning family were unable to attend hospital, these patients frequently died surrounded by strangers. This review aimed to characterise the demographics and circumstances of the patients dying in the ED and identify common factors which lead to attendance.MethodA review of electronic records was undertaken for all patients who died in the ED of a large tertiary teaching hospital in the East of England between January and September 2020. Data collected included;reasons for admission;age and living arrangements;day and time of admission;date of last admission;specialist Palliative Care involvement;previous DNACPR or Advanced Care Planning (ACP) decisions;length of stay in ED and date of death;coroner involvement and MCCD cause of death.Results69 patients died in the ED in the reviewed period. 64 sets of electronic case notes were reviewed (exclusions n=5). 14/64 were known to a Palliative Care Team, and of those, half presented out of hours (OOH), 11 had had at least one hospital admission within the last 6 months and 6 did not have a DNACPR decision.ConclusionMultiple contributing factors were identified which lead to patients known to Palliative Care dying in the ED. These include missed opportunities for Advanced Care Planning discussions, ACP decisions not being communicated between hospital and community teams, and community Palliative Care services sometimes being inaccessible. These factors represent potential targets to transform and improve Palliative Care input and support for Emergency Departments, and improve access to services OOH.