Palliative home care patients’ emergency department visits near end of life: decision making and outcomes
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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 source (direct Gemma or distilled Codex), 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".