Why do Palliative Care Patients Present to the Emergency Department? Avoidable or Unavoidable?
Bibliographic record
Abstract
INTRODUCTION: Presentations by patients with advanced illness to the Emergency Department (ED) towards the end-of-life can be distressing for both patients and caregivers. With an understanding of why patients present, interventions to avoid these presentations close to the end-of-life may be possible. AIMS: To identify patients under the specialist palliative care service (SPCS) who attended the ED over 6 months and to determine if these presentations were potentially avoidable. Presentations were deemed avoidable if the problem could have been dealt with in another manner, i.e. by the home care team or by the family physician, or in another setting, such as by admission to the hospice. RESULTS: Thirty-five ED presentations by 30 patients were included. Eighteen (60%) male, mean age 68.7 (47-89). Twenty-two (63%) ED presentations were outside working hours. The main reasons for attending were: dyspnea (9, 26%), nausea/vomiting/constipation (6, 17%) and uncontrolled pain (5, 14.5%). Thirty-three (94%) of the 35 presentations resulted in hospitalization. The average length of time spent in the ED was 9.2 hours (3-24). Referral to the hospital SPCS was made in 20 (60%) cases. Fifteen (50%) patients died within one month of presentation. Eighteen (51.5%) ED presentations were deemed potentially avoidable. CONCLUSION: Many ED presentations by palliative care patients may be avoidable. Appropriate sharing of information to on-call doctors, creating confidence in carers and providing extra practical supports is necessary. A comprehensive, coordinated specialist palliative care approach across community and acute services may help ensure patients are not sent to the ED inappropriately.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".