Emergency Medicine Department, National University Hospital, National University Health System, Singapore.
Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
BMJ Open. 2020 Apr 28;10(4):e036598. doi: 10.1136/bmjopen-2019-036598.
Patients at their end-of-life (EOL) phase frequently visit the emergency department (ED) due to their symptoms, yet the environment and physicians in ED are not traditionally equipped or trained to provide palliative care. This multicentre study aims to measure the current quality of EOL care in ED to identify gaps, formulate improvements and implement the improved EOL care protocol. We shall also evaluate healthcare resource utilisation and its associated costs.
This study employs a quasiexperimental interrupted time series design using both qualitative and quantitative methods, involving the EDs of three tertiary hospitals in Singapore, over a period of 3 years. There are five phases in this study: (1) retrospective chart reviews of patients who died within 5 days of ED attendance; (2) pilot phase to validate the CODE questionnaire in the local context; (3) preimplementation phase; (4) focus group discussions (FGDs); and (5) postimplementation phase. In the prospective cohort, patients who are actively dying or have high likelihood of mortality this admission, and whose goal of care is palliation, will be eligible for inclusion. At least 140 patients will be recruited for each preimplementation and postimplementation phase. There will be face-to-face interviews with patients' family members, review of medical records and self-administered staff survey to evaluate existing knowledge and confidence. The FGDs will involve hospital and community healthcare providers. Data obtained from the retrospective cohort, preimplementation phase and FGDs will be used to guide prospective improvement and protocol changes. Patient, family and staff relevant outcomes from these changes will be measured using time series regression.
The study protocol has been reviewed and ethics approval obtained from the National Healthcare Group Domain Specific Review Board, Singapore. The results from this study will be actively disseminated through manuscript publications and conference presentations.
NCT03906747.
处于生命终末期（EOL）的患者经常因症状而频繁前往急诊科（ED）就诊，但 ED 的环境和医生传统上并未配备或接受过提供姑息治疗的培训。这项多中心研究旨在衡量 ED 中 EOL 护理的当前质量，以发现差距、制定改进措施并实施改进后的 EOL 护理方案。我们还将评估医疗资源的利用情况及其相关成本。
这项研究采用准实验性中断时间序列设计，结合定性和定量方法，涉及新加坡三家三级医院的 ED，历时 3 年。该研究有五个阶段：（1）对 ED 就诊后 5 天内死亡的患者进行回顾性病历审查；（2）在当地背景下验证 CODE 问卷的试点阶段；（3）实施前阶段；（4）焦点小组讨论（FGD）；（5）实施后阶段。在前瞻性队列中，将招募符合以下条件的患者：积极临终或此次入院极有可能死亡且其护理目标为姑息治疗的患者。每个实施前和实施后阶段将招募至少 140 名患者。将对患者家属进行面对面访谈、病历审查和自我管理的员工调查，以评估现有知识和信心。FGD 将涉及医院和社区医疗保健提供者。从回顾性队列、实施前阶段和 FGD 中获得的数据将用于指导前瞻性改进和方案变更。使用时间序列回归来衡量这些变更对患者、家属和员工的相关结果。
该研究方案已在新加坡国家医疗保健集团特定领域审查委员会进行了审查和伦理批准。该研究的结果将通过手稿出版物和会议演讲积极传播。
NCT03906747。
