Palliative home care patients’ emergency department visits near end of life: decision making and outcomes
Notice bibliographique
Résumé
Introduction & Aims Some palliative patients have one or multiple ED visits near their end of life. People who stay home are more likely to die at home or in hospice compared to those admitted to acute care. This study was to describe decisions and outcomes of palliative home care patients who go to Emergency (ED) within the last 6 weeks of life in one metropolitan zone of Alberta Health Services. Description In the 2017-2018 fiscal year, there were 1874 palliative home care patients in the Edmonton Zone, of whom 646 (34.4 %) patients went to ED in the last 6 weeks of life. Of these, home care and emergency charts were reviewed for 194 deceased patients, selected by CTAS score, urban and suburban/rural, and unusual events: died in the ED, left the ED, admitted to critical care. Key Findings Patients who went to ED were more likely to be male (59%) and older than 65 years (65 %). Most had cancer as a primary diagnosis (82.6%). More than 50 % went to ED more than once. For the majority (74.3%), the final ED visit was within 2 weeks of death; almost half were within 7 days (49.2%). Primary presenting concerns were pain (24.9%) and dyspnea (21.5%). There was no known goal of care reported or documented in either chart for 28.2%. In ED 85% had documentation that their goals or wishes for care were reviewed or discussed, of whom 9% had their first order written and 47.8% had their order changed to align care with their wishes and illness. 44.6% spent 8 hours or less in ED; 21 patients died in the ED. Most patients (73.8%) identified a preference to die at home or hospice; some wishes were unknown (7.2 %), others had not been discussed (17%); 77.5% died in hospital. Conclusions and Implications This study highlights the ongoing opportunity to meet palliative care needs, including communication and collaboration between ED and home care. Some patients presented urgently to home care near end of life; others were diagnosed in ED and then referred. Additional anticipatory guidance may benefit those who present to the ED near end of life but prefer to die at home or hospice.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».