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. 2023 Feb 24;59(3):456.
doi: 10.3390/medicina59030456.

Perspectives towards End-of-Life Care in the Emergency Department of Tertiary Public Hospitals-A Qualitative Analysis

Ling Tiah  1 , Mui Teng Chua  2   3 , Win Sen Kuan  2   3 , Alina Tan  4 , Eileen Tay  2 , Rakhee Yash Pal  2 , Chaoyan Dong  5
Affiliations

Perspectives towards End-of-Life Care in the Emergency Department of Tertiary Public Hospitals-A Qualitative Analysis

Ling Tiah et al. Medicina (Kaunas). .

Abstract

Background and Objectives: End-of-life care in the emergency department (ED) is gaining importance along with the growth in the ageing population and those with chronic and terminal diseases. To explore key stakeholders' perspectives and experiences regarding end-of-life care in the ED. Materials and Methods: A descriptive qualitative study was conducted from November 2019 to January 2020. Study participants were recruited from the EDs of three tertiary hospitals and community care settings in Singapore through purposive sampling. Data collection included focus group discussions with 36 ED staff, 16 community healthcare professionals, and one-on-one semi-structured interviews with seven family members. Results: Three main themes and several subthemes emerged from the data analysis. (1) Reasons for ED visits were attributed to patients' preferences, families' decisions, limited services and capabilities in the community, and ease of access. (2) Barriers to providing end-of-life management in the ED included: conflicting priorities of staff, cramped environment, low confidence, ineffective communication, and lack of standardised workflows. (3) Discussion about continuity of end-of-life care beyond the ED uncovered issues related to delayed transfer to inpatient wards, challenging coordination of terminal discharge from the ED, and limited resources for end-of-life care in the community. Conclusions: Key stakeholders reported challenges and shared expectations in the provision of end-of-life care in the ED, which could be optimised by multidisciplinary collaborations addressing environmental factors and workflows in the ED. Equipping ED physicians and nurses with the necessary knowledge and skills is important to increase competency and confidence in managing patients attending the ED at the end of their lives.

Keywords: emergency department; end-of-life care; qualitative design.

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Conflict of interest statement

R.Y.P. was awarded the Clinician Scientist Salary Support Programme by the National Medical Research Council (CSSSP19Nov-0007). The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results. The remaining authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Analysis of data to identify theme.
Figure 2
Figure 2
Coding frame.
Figure 3
Figure 3
Themes and subthemes.
See this image and copyright information in PMC

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