Elderly patients with serious chronic diseases often present to the emergency department (ED) in the last moments of their life, many with identifiable trajectories of dying: organ failure, advanced cancer and chronic frailty. These patients and their families may benefit more from good end-of-life (EOL) care provision than the standard resuscitative approach. This study aimed to determine the incidence and nature of death among patients aged ≥ 65 years in an ED, and characterise their trajectories of dying. This was a retrospective study carried out over a one-year period in a tertiary ED. All ED deaths in patients aged ≥ 65 years over this period were included. Information on the patients' demographics, comorbidities and details of death were extracted from the hospital's electronic medical records database. Based on the available information, their Karnofsky Performance Status (KPS) scores and trajectories of dying were ascertained. In one year, 197 patients aged ≥ 65 years died in the ED, 51.3% of whom suffered from serious chronic illnesses, with identifiable trajectories of dying. Of these patients, 46.5% had premorbid functional limitation with KPS scores of 0-40. However, only 14.9% of patients had a pre-existing resuscitation status and 74.3% received aggressive resuscitative measures. There is a significant burden of EOL care needs among elderly patients in the ED. Many of these patients have chronic illness trajectories of dying. This study underscores the need for improvement in EOL care provision for dying patients and their families in the ED.

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.

Background and Objectives: The increasing prevalence of end-of-life care needs in the emergency department necessitates training for emergency staff in managing terminal symptoms, facilitating serious illness conversations and ensuring goal-concordant interventions. This study aims to evaluate the longitudinal effects of an end-of-life care educational intervention on various emergency professionals. Materials and Methods: An interrupted time series study was conducted among emergency physicians and nurses at three public healthcare institutions over two-and-a-half years. The study had three phases: Phase 1—5 pre-intervention surveys, Phase 2—intervention with an online training course, and Phase 3—5 post-intervention surveys. The impact of the intervention was scored based on staff perceptions of end-of-life care in 3 domains: 1. Knowledge of palliative care (Knowledge), 2. Quality of end-of-life care provided (Care), and 3. Ability to communicate with patients and families (Communication). Results: There were 990 participants with 6450 questionnaires distributed and an 87% response rate of completed questionnaires. Phase 3 had generally higher levels of agreement in all 3 domains compared to Phase 1, with a continued upward trend in Knowledge scores. Upward trends in the Care and Communication domains were less pronounced. Among the 631 (out of 990) participants who completed the training, test scores showed a median improvement of 37.5% (p < 0.001). Conclusions: This study supports the feasibility of online end-of-life care training tailored specifically for emergency professionals, with promising results in the Knowledge, Care, and Communication domains. The findings can help guide the further development of training programs or the adoption of similar interventions for basic palliative care training for emergency physicians and nurses.