News: Increased deaths in ED highlight need for improving end-of-life care, researchers say

Deaths in emergency departments (ED) are estimated to account for 11.3% of total deaths in the U.S. from 2010 to 2019, according to a new research article published by JAMA Network Open. Also, a third of people who died nationally had visited an ED within one month of their death, a proportion that has increased 42% over a decade. Among patients older than 80 with ED visits, nearly one in 12 died within a month of visiting, HealthLeaders reported.

The study used Optum electronic health record data from 2010 to 2020, as well as the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and U.S. Census. It found patients with ED visits resulting in death tended to be older, male, and with higher Charlson Comorbidity Index scores. Since many people consider dying at home or in a hospice facility better or more comforting than dying in the hospital, ED deaths may lead to protracted grief and psychological distress for families. The study’s co-authors note this increasing proportion of ED deaths highlights a growing need for better end-of-life care in the ED setting.

“Patients with death proximate to their final ED encounter are older and have significantly more comorbidities compared with the overall ED population,” the study’s co-authors wrote. “These patients may exhibit identifiable trajectories of dying that offer an opportunity to avoid unwanted aggressive care or hospitalization at end of life.” The general consensus that delivering high-quality end-of-life care in the ED is currently an unmet need may likely be due to time constraints, patient volume, and environmental factors, they said.

The co-authors suggested the following for improving end-of-life care:

• Include grief and bereavement resources in ED programs
• Teach ED practitioners and staff core primary palliative care skills (including symptom management for actively dying patients, the ability to give serious news, and focus on talking to patients and families about goals of care)
• Develop and implement new policies in ED programs
• Allocate additional resources for training
• Develop relations with community palliative care and hospice programs to follow up with the large number of patients who have impending or ongoing palliative care needs

“These findings highlight a pressing need to develop systems and resources to support end-of-life care in the ED,” the authors concluded.

Editor’s note: To read HealthLeaders’ coverage of this story, click here. To read the JAMA Network Open article, click here.