Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs.

<h4>Introduction</h4>This study examined emergency department (ED) presentations of patients with end of life (EOL) conditions and patients having met and unmet palliative care needs were compared.<h4>Methods</h4>Presentations for EOL conditions were prospectively identified...

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Autores principales:	Scott W Kirkland, Miriam Garrido Clua, Maureen Kruhlak, Cristina Villa-Roel, Stephanie Couperthwaite, Esther H Yang, Adam Elwi, Barbara O'Neill, Shelley Duggan, Amanda Brisebois, Brian H Rowe
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1c3edda2df294363a9c346c03719472a
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spelling	oai:doaj.org-article:1c3edda2df294363a9c346c03719472a2021-12-02T20:14:09ZComparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs.1932-620310.1371/journal.pone.0257501https://doaj.org/article/1c3edda2df294363a9c346c03719472a2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0257501https://doaj.org/toc/1932-6203<h4>Introduction</h4>This study examined emergency department (ED) presentations of patients with end of life (EOL) conditions and patients having met and unmet palliative care needs were compared.<h4>Methods</h4>Presentations for EOL conditions were prospectively identified and screened for palliative care needs. Descriptive data were reported as proportions, means or medians. Bi-variable analysis for dichotomous and continuous variables were performed by chi-squared and T-tests (p≤0.01), respectively. A multivariable logistic regression model identified factors associated with having unmet palliative needs and reported adjusted odds ratios (aOR) with 95% confidence intervals (CI).<h4>Results</h4>Overall, 663 presentations for EOL conditions were identified; 518 (78%) involved patients with unmet palliative care needs. Presentations by patients with unmet palliative needs were more likely to involve consultations (80% vs. 67%, p = 0.001) and result in hospitalization (69% vs. 51%, p<0.001) compared to patients whose palliative needs were met. Patients with unmet palliative care needs were more likely to have previous ED visits (73% unmet vs. 48% met; p<0.001). While medication, procedures, investigations and imaging ordering were high across all patients with EOL conditions, there were no significant differences between the groups. Consultations with palliative specialists in the ED (6% unmet vs. 1% met) and following discharge (29% unmet vs. 18% met) were similarly uncommon. Patients having two or more EOL conditions (aOR = 2.41; 95% CI: 1.16, 5.00), requiring hospitalization (aOR = 1.93; 95% CI: 1.30, 2.87), and dying during the ED visit (aOR = 2.15; 95% CI: 1.02, 4.53) were strongly associated with having unmet palliative care needs.<h4>Conclusions</h4>Most ED presentations for EOL conditions were made by patients with unmet palliative care needs, who were significantly more likely to require consultation, hospitalization, and to die. Referrals to palliative care services during and after the ED visit were infrequent, indicating important opportunities to promote these services.Scott W KirklandMiriam Garrido CluaMaureen KruhlakCristina Villa-RoelStephanie CouperthwaiteEsther H YangAdam ElwiBarbara O'NeillShelley DugganAmanda BriseboisBrian H RowePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 9, p e0257501 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Scott W Kirkland Miriam Garrido Clua Maureen Kruhlak Cristina Villa-Roel Stephanie Couperthwaite Esther H Yang Adam Elwi Barbara O'Neill Shelley Duggan Amanda Brisebois Brian H Rowe Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs.
description	<h4>Introduction</h4>This study examined emergency department (ED) presentations of patients with end of life (EOL) conditions and patients having met and unmet palliative care needs were compared.<h4>Methods</h4>Presentations for EOL conditions were prospectively identified and screened for palliative care needs. Descriptive data were reported as proportions, means or medians. Bi-variable analysis for dichotomous and continuous variables were performed by chi-squared and T-tests (p≤0.01), respectively. A multivariable logistic regression model identified factors associated with having unmet palliative needs and reported adjusted odds ratios (aOR) with 95% confidence intervals (CI).<h4>Results</h4>Overall, 663 presentations for EOL conditions were identified; 518 (78%) involved patients with unmet palliative care needs. Presentations by patients with unmet palliative needs were more likely to involve consultations (80% vs. 67%, p = 0.001) and result in hospitalization (69% vs. 51%, p<0.001) compared to patients whose palliative needs were met. Patients with unmet palliative care needs were more likely to have previous ED visits (73% unmet vs. 48% met; p<0.001). While medication, procedures, investigations and imaging ordering were high across all patients with EOL conditions, there were no significant differences between the groups. Consultations with palliative specialists in the ED (6% unmet vs. 1% met) and following discharge (29% unmet vs. 18% met) were similarly uncommon. Patients having two or more EOL conditions (aOR = 2.41; 95% CI: 1.16, 5.00), requiring hospitalization (aOR = 1.93; 95% CI: 1.30, 2.87), and dying during the ED visit (aOR = 2.15; 95% CI: 1.02, 4.53) were strongly associated with having unmet palliative care needs.<h4>Conclusions</h4>Most ED presentations for EOL conditions were made by patients with unmet palliative care needs, who were significantly more likely to require consultation, hospitalization, and to die. Referrals to palliative care services during and after the ED visit were infrequent, indicating important opportunities to promote these services.
format	article
author	Scott W Kirkland Miriam Garrido Clua Maureen Kruhlak Cristina Villa-Roel Stephanie Couperthwaite Esther H Yang Adam Elwi Barbara O'Neill Shelley Duggan Amanda Brisebois Brian H Rowe
author_facet	Scott W Kirkland Miriam Garrido Clua Maureen Kruhlak Cristina Villa-Roel Stephanie Couperthwaite Esther H Yang Adam Elwi Barbara O'Neill Shelley Duggan Amanda Brisebois Brian H Rowe
author_sort	Scott W Kirkland
title	Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs.
title_short	Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs.
title_full	Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs.
title_fullStr	Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs.
title_full_unstemmed	Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs.
title_sort	comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/1c3edda2df294363a9c346c03719472a
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Comparison of characteristics and management of emergency department presentations between patients with met and unmet palliative care needs.

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