Why should emergency physicians take up the end-of-life banner? One study showed that 96 percent of decedents were admitted through the emergency department in the last 108 days of their lives.2 Another study noted that 77 percent of patients had their first documented discussion of end-of-life preferences three days before death, and 82 percent of patients with critical care rendered in the hospital left the hospital without advanced directives being articulated.
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ACEP Now: Vol 33 – No 01 – January 2014There is a performance gap in this important aspect of care. There is a growing body of evidence that suggests when it comes to the end of life, patients “can’t always get what they want.” Well, maybe they should, and emergency physicians are best positioned to facilitate these discussions.
Shari Welch, MD, FACEP, is a practicing emergency physician with Utah Emergency Physicians and a research fellow at the Intermountain Institute for Health Care Delivery Research. She has written numerous articles and three books on ED quality, safety, and efficiency. She is a consultant with Quality Matters Consulting and her expertise is in ED Operations.
References
- Smith AK, McCarthy E, Weber E, et al. Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff (Millwood). 2012;31:1277-1285.
- Rosenwax LK, McNamara BA, Murray K, McCabe RJ, Aoun SM, Currow DC. Hospital and emergency department use in the last year of life: a baseline for future modifications to end-of-life care. Med J Aust. 2011;194:570-573.
- Gaw A, Doherty S, Hungerford P, May J. When death is imminent – documenting end-of-life decisions. Aust Fam Physician. 2012;41:614-617.
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