15 A ‘good’ death in the emergency department? Identifying patients nearing the end of life in the ED

An important aspect of end of life (EOL) care is identifying patients entering this stage, thus enabling clinicians to make plans and referrals. Despite many patients wishing to die at home, a significant proportion will attend the ED. Hence it is important that ED doctors identify and support these individuals. Given the nature of work in ED, this is challenging. The Supportive and Palliative Care Indicators Tool (SPICT™) can help with patient identification. A sample of 30 patients aged ≥60 attending the Whittington Hospital ED were assessed using the SPICT™ criteria. For patients who met EOL criteria, it was documented what action was taken, including Advanced Care Planning, DNACPR, referral to Palliative Care or discussion about preferred place of care and of death. 10 met the criteria. Action was taken in 40% of these, most commonly Advanced Care Planning and DNACPR discussion. Use of the SPICT™, in poster or app format, could help ED doctors to identify EOL patients, thus prompting them to take action. Further ways to improve the identification of EOL patients in the ED include use of tools such as the 3 triggers outlined by the GSF Prognostic Indicator Guide for GPs. Other ideas include an alert system to flag patients known to Palliative Care. Rapid discharge pathways for patients who wish to die at home is also an important initiative which relies on rapid identification and close working with community teams.