Beyond code status: palliative care begins in the emergency department

A 78-year-old-woman with advanced heart failure and chronic obstructive pulmonary disease presents to the emergency department (ED) with respiratory failure. In the ED she is placed on non-invasive ventilation and administered furosemide 80 mg iv. The workup is consistent with a new non-ST elevation myocardial infarction and heart failure exacerbation. Over the last six months she has had three hospital admissions and there is no advance care plan.

Sounds familiar, right?

The aging population is increasingly dying from chronic rather than acute illness. Approximately one third of all older patients will visit an Emergency Department (ED) in the last month of life.
With increasingly complex medical needs, these patients present with challenging complaints such as functional loss, bounce-back visits for uncontrolled symptoms, and caregiver fatigue. Early palliative intervention directly affects patients’ quality of life and use of the health care system and should be initiated in the ED.

Deelnemers leren interactief wat palliatieve zorg inhoudt en welke aspecten van belang zijn binnen de spoedeisende geneeskunde. Denk hierbij aan introductie van de Surprise Question en de Patient Dignity Question, proactieve zorgplanning en de rol van kwetsbaarheid.