Chor Wei Ping Daniel, Wong Sarah Yun Ping, Ikbal Muhammad Fadhli Bin Mohamad, Kuan Win Sen, Chua Mui Teng, Pal Rakhee Yash
1 Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore.
2 Ministry of Health Holdings Pte Ltd, Singapore, Singapore.
Am J Hosp Palliat Care. 2019 Nov;36(11):941-946. doi: 10.1177/1049909119836931. Epub 2019 Mar 12.
Terminally ill patients at their end-of-life (EOL) phase attending the emergency department (ED) may have complex and specialized care needs frequently overlooked by ED physicians. To tailor to the needs of this unique group, the ED in a tertiary hospital implemented an EOL pathway since 2014. The objective of our study is to describe the epidemiological characteristics, symptom burden and management of patients using a protocolized management care bundle.
We conducted an observational study on the database of EOL patients over a 28-month period. Patients aged 21 years and above, who attended the ED and were managed according to these guidelines, were included. Clinical data were extracted from the hospital's electronic medical records system.
Two hundred five patients were managed under the EOL pathway, with a slight male predominance (106/205, 51.7%) and a median age of 78 (interquartile range 69-87) years. The majority were chronically frail (42.0%) or diagnosed with cancer or other terminal illnesses (32.7%). The 3 most commonly experienced symptoms were drowsiness (66.3%), dyspnea (61.5%), and fever (29.7%). Through the protocolized management care bundle, 74.1% of patients with dyspnea and/or pain received opiates while 59.5% with copious secretions received hyoscine butylbromide for symptomatic relief.
The institution of a protocolized care bundle is feasible and provides ED physicians with a guide in managing EOL patients. Though still suboptimal, considerable advances in EOL care at the ED have been achieved and may be further improved through continual education and enhancements in the care bundle.
处于临终阶段的晚期绝症患者前往急诊科就诊时，可能有一些复杂且特殊的护理需求，而这些需求常常被急诊科医生忽视。为了满足这一特殊群体的需求，一家三级医院的急诊科自2014年起实施了临终关怀路径。我们研究的目的是使用标准化管理护理套餐来描述患者的流行病学特征、症状负担及管理情况。
我们对一个为期28个月的临终关怀患者数据库进行了观察性研究。纳入年龄在21岁及以上、前往急诊科并按照这些指南进行管理的患者。临床数据从医院的电子病历系统中提取。
205例患者按照临终关怀路径进行管理，男性略占优势（106/205，51.7%），中位年龄为78岁（四分位间距69 - 87岁）。大多数患者长期体弱（42.0%）或被诊断患有癌症或其他晚期疾病（32.7%）。最常出现的3种症状是嗜睡（66.3%）、呼吸困难（61.5%）和发热（29.7%）。通过标准化管理护理套餐，74.1%的呼吸困难和/或疼痛患者接受了阿片类药物治疗，而59.5%有大量分泌物的患者接受了丁溴东莨菪碱以缓解症状。
制定标准化护理套餐是可行的，并为急诊科医生管理临终关怀患者提供了指导。尽管仍不尽人意，但急诊科在临终关怀方面已取得了相当大的进展，通过持续教育和完善护理套餐可能会进一步改善。
