Daniela Vasquez
Clinical Nurse Specialist, Australia
Title: Time Is Precious (TIP) ): Person centred end of life care in the emergency department
Biography
Biography: Daniela Vasquez
Abstract
A primary focus of Emergency Department (ED) is to provide urgent medical treatment in the hope of minimising suffering and preventing treatment delays for patients whose death is imminent or inevitable. The focus of palliative care is on quality of life through symptom management, utilising a multi-disciplinary approach, whilst providing support to the carer and family. Though not oppositional to the ED process, there are gaps in the approaches to achieving patients’ goals of care. Additionally, palliative care patients are often forgotten or seen as low priority, and as a result they are having delayed medical review, commencement of inapplicable investigations and inappropriate management. Further, they are not receiving appropriate nursing care and unnecessary stress is put on the patient and families by exposing them to an undesirable busy environment with little privacy and compassion.
There is an expected 21% increase in patients with palliative care needs using EDs by 2021 in the South Western Sydney Local Health District. This will translate into longer wait times unless a system to cater for this patient cohort is in place.
In response to this need we have designed a detailed model of service named Time is Precious (TIP). The aim of the TIP Project is to improve the care of patients who present to the ED in their last week’s/ days of life. TIP involves early identification, escalation particularly for acutely distressed patients or families, fast-tracked medical review to improve disposition planning, and discussion on goals of care (GOC) which empowers the patient and the family to make a decision where to die at home or the hospital.
We have developed the concept of a ED Specific End of Life Care Project in the ED for patients with palliative care needs, consisting of a guide to assist with care and disposition planning, checklists, education, a resource folder and a collaborative approach to care planning, incorporating the multidisciplinary team in the ED and extending to inpatient medical and nursing teams.