scholarly journals Management of oncology-related emergencies at the emergency department: A long-term undertaking

2020 ◽  
pp. 102490792095367
Author(s):  
Wei Lin Tallie Chua ◽  
Shi En Joanna Chan ◽  
Gillianne Lai ◽  
Looi Yee Tracy Yong ◽  
Ravindran Kanesvaran ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Early Warning ◽  
Hospital Setting ◽  
Well Being ◽  
Clinical Severity ◽  
Equal Distribution ◽  
Singapore General Hospital ◽  
Number Of Patients ◽  
Early Warning Scores

Background: The emergency department at the Singapore General Hospital is an emergency department with an annual census of 140,000 and oncology-related attendances of about 4000 (2.8%). These patients are often admitted for further care. Palliative care in the emergency department for these patients is often minimal. The aim of this study was to determine the state of current management of oncology-related emergencies at the Singapore General Hospital’s emergency department, hence identifying specific areas for intervention. Methods: We carried out a retrospective data review of all Singapore General Hospital’s emergency department patients who had either cancer-related diagnoses or were admitted to the Medical Oncology Department in October 2018. Simple statistical analysis was then performed using IBM SPSS version 21. Results: Of 308 identified patients, there was approximately equal distribution by sex. The women were generally younger than the men (61.33 ± 13.63 years vs 67.36 ± 12.02 years, p = 0.063, confidence interval −8.94 to −3.13). Seventy-two (23.4%) of the patients arrived at emergency department by ambulance. The mean emergency department length of stay was 4.25 h. About half of the patients had either lung, colorectal, or breast as their primary site of cancer. There was no correlation between clinical severity according to the National Early Warning Scores and triage complaint-type or emergency clinical diagnosis. More than 90% were admitted, with about 32.6% dying during their inpatient stay. High National Early Warning Scores were significantly associated with mortality. Conclusion: There is large potential for interventions to improve patient well-being in the pre-hospital setting and emergency department. Given the sizable number of patients with poor outcomes, palliative care is also of paramount importance.

scholarly journals Holistic treatment of the patient in palliative care – The nurses view

2016 ◽  
Vol 15 (4) ◽  
pp. 42-47
Author(s):  
Bojana Filej ◽  
Boris Miha Kaučič ◽  
Boštjan Žvanut ◽  
Mojca Saje
Keyword(s):  
Palliative Care ◽  
Hospital Setting ◽  
Well Being ◽  
Integrated Treatment ◽  
Social Aspect ◽  
Physical Aspect ◽  
Community Nursing ◽  
Quantitative Methodology ◽  
Holistic Treatment ◽  
Starting Point

Abstract Introduction. Man is a unique, unrepeatable whole in space and time and that is why he requires a holistic treatment, taking into account physical, psychological, social and spiritual factors. The balanced factors can ensure human well-being and his quality of life. Integrated treatment is especially important for patients in palliative care, which was the basic starting point of our research. In our research we wanted to establish whether the patients in palliative care are treated holistically from the perspective of the nurses and where are the specific aspects of palliative care (psychological, physical, social and spiritual) more visible - in the hospitals or in the home environment.Material and methods. The questionnaire survey was based on the empirical quantitative methodology; a descriptive causal non-experimental method was used. The number of the included sample was 127 nurses (92 hospital nurses, 35 community nurses). To test the differences between the groups (hospital, community nursing), the single factor analysis of variance was used. All the research participants were ensured anonymity and they had the right to withdraw from the study before or during the questionnaire completion.Results. The physical aspect of the treatment was statistically significantly higher assessed by nurses in a hospital setting (̅χ =3.83; s=1.012; p=0.042). The psychological and spiritual aspects were higher assessed in community nursing setting and social aspect in hospital setting.Conclusions. Our research has highlighted the shortcomings of the holistic approach in palliative care. Nurses need in-depth knowledge and skills as well as practice within each holistic domain to perform quality treatment of palliative patients.

The discrimination of quick Paediatric Early Warning Scores in the pre‐hospital setting

Anaesthesia ◽  
2020 ◽  
Vol 75 (3) ◽  
pp. 353-358 ◽  
Author(s):  
A. R. Corfield ◽  
L. Clerihew ◽  
E. Stewart ◽  
H. Staines ◽  
D. Tough ◽  
...  
Keyword(s):  
Early Warning ◽  
Hospital Setting ◽  
Early Warning Scores

scholarly journals Death in the Emergency Department: A Retrospective Analysis of Mortality in a Swiss University Hospital

2019 ◽  
Vol 2019 ◽  
pp. 1-9
Author(s):  
Eric P. Heymann ◽  
Alexandre Wicky ◽  
Pierre-Nicolas Carron ◽  
Aristomenis K. Exadaktylos
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Palliative Care ◽  
Retrospective Analysis ◽  
Clinical Severity ◽  
University Hospital ◽  
Advanced Directives ◽  
Risk Of Death ◽  
Public Data ◽  
Patients At Risk

Acute treatment in emergency medicine revolves around the management and stabilization of sick patients, followed by a transfer to the relevant medical specialist, be it outpatient or inpatient. However, when patients are too sick to be stabilized, i.e., when the care provided in the Emergency Department (ED) may not be sufficient to enable transfer, death may occur. This aspect of emergency medicine is often overlooked, and very few public data exist regarding who dies in the ED. The following retrospective analysis of the mortality figures of a Swiss university hospital from January 1st 2013 to December 31st 2016 attests to the fact that with an incidence of 2.6/1,000, death does occur in the ED. With a broad range of aetiologies, clinical severity at presentation has a high correlation with mortality, a finding that reinforces the necessity of good triage system. Our analysis goes on to show that however (in)frequent death in the ED may be, there exists a lack of advanced directives in a majority of patients (present in only 14.8% of patients during the time of study), a worrying and often challenging situation for Emergency Medicine (EM) teams faced with premorbid patients. Furthermore, a lack of such directives may hinder access to palliative care, as witnessed in part by the fact that palliative measures were only started in 16.6% of patients during the study. The authors hope this study will serve as a stepping stone to promote further research and discussion into early identification methods for patients at risk of death in the ED, as well as motivate a discussion into the integration of palliative care within the ED and EM training curriculum.

Palliative medicine in the emergency department: symptom control and aggressive care

2021 ◽  
pp. bmjspcare-2021-003332
Author(s):  
Raquel de Oliveira ◽  
Carolina B. Lobato ◽  
Leonardo Maia-Moço ◽  
Mariana Santos ◽  
Sara Neves ◽  
...  
Keyword(s):  
Emergency Department ◽  
Palliative Care ◽  
Palliative Medicine ◽  
Symptom Control ◽  
Well Being ◽  
Blood Collection ◽  
Intravenous Fluid Therapy ◽  
Aggressive Care ◽  
Aggressive Interventions ◽  
Time Of Admission

ObjectivesIdentifying the prevalence of palliative care (PC) needs among patients who die at the emergency department (ED) and to assess symptom control and aggressiveness of care.MethodsWe conducted a decedent cohort study of adults deceased at the ED of a Portuguese teaching hospital in 2016. PC needs were identified using the National Hospice Organization terminality criteria and comorbidities measurement by the Charlson’s Index.Results384 adults died at the ED (median age 82 (IQR 72–89) years) and 78.4% (95% CI 73.9% to 82.2%) presented PC needs. Only 3.0% (n=9) were referred to the hospital PC team. 64.5%, 38.9% and 57.5% experienced dyspnoea, pain and confusion, respectively. Dyspnoea was commonly medicated (92%), against 56% for pain and 8% for confusion. Only 6.3% of the patients were spared from aggressive interventions, namely blood collection (86.0%) or intravenous fluid therapy (63.5%). The burden of aggressive interventions was similar between those with or without withhold cardiopulmonary resuscitation order (median 3 (2–4) vs 3 (2–5)), p=0.082.ConclusionsNearly four out of five adults who died at the ED had PC needs at the time of admission. Most experienced poor symptom control and care aggressiveness in their last hours of life and were mostly unknown to the PC team. The findings urge improvements in the care provided to patients with PC needs at the ED, focusing on patient well-being and increased PC referral.

scholarly journals Paediatric early warning scores are predictors of adverse outcome in the pre-hospital setting: A national cohort study

Resuscitation ◽  
2018 ◽  
Vol 133 ◽  
pp. 153-159 ◽  
Author(s):  
A.R. Corfield ◽  
D. Silcock ◽  
L. Clerihew ◽  
P. Kelly ◽  
E. Stewart ◽  
...  
Keyword(s):  
Cohort Study ◽  
Early Warning ◽  
Adverse Outcome ◽  
Hospital Setting ◽  
Early Warning Scores ◽  
National Cohort

scholarly journals Examining the utility of the Hamilton early warning scores (HEWS) at triage: Retrospective pilot study in a Canadian emergency department

CJEM ◽  
2017 ◽  
Vol 20 (2) ◽  
pp. 266-274 ◽  
Author(s):  
Steven Skitch ◽  
Benjamin Tam ◽  
Michael Xu ◽  
Laura McInnis ◽  
Anthony Vu ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Early Warning ◽  
Vital Signs ◽  
Roc Curves ◽  
Early Warning Score ◽  
Critical Event ◽  
Discriminative Ability ◽  
Early Warning Scores ◽  
Patients At Risk

ABSTRACTObjectivesEarly warning scores use vital signs to identify patients at risk of critical illness. The current study examines the Hamilton Early Warning Score (HEWS) at emergency department (ED) triage among patients who experienced a critical event during their hospitalization. HEWS was also evaluated as a predictor of sepsis.MethodsThe study population included admissions to two hospitals over a 6-month period. Cases experienced a critical event defined by unplanned intensive care unit admission, cardiopulmonary resuscitation, or death. Controls were randomly selected from the database in a 2-to-1 ratio to match cases on the burden of comorbid illness. Receiver operating characteristic (ROC) curves were used to evaluate HEWS as a predictor of the likelihood of critical deterioration and sepsis.ResultsThe sample included 845 patients, of whom 270 experienced a critical event; 89 patients were excluded because of missing vitals. An ROC analysis indicated that HEWS at ED triage had poor discriminative ability for predicting the likelihood of experiencing a critical event 0.62 (95% CI 0.58-0.66). HEWS had a fair discriminative ability for meeting criteria for sepsis 0.77 (95% CI 0.72-0.82) and good discriminative ability for predicting the occurrence of a critical event among septic patients 0.82 (95% CI 0.75-0.90).ConclusionThis study indicates that HEWS at ED triage has limited utility for identifying patients at risk of experiencing a critical event. However, HEWS may allow earlier identification of septic patients. Prospective studies are needed to further delineate the utility of the HEWS to identify septic patients in the ED.

Sign in / Sign up

Export Citation Format

Share Document