Death and Dying in the Emergency Department: A New Model for End-of-Life Care

BACKGROUND

Death and dying remain taboo subjects in society today and therefore people may come to the end of their life without having thought about what death and dying might be like and what it is to have a good death. The purpose of this qualitative study was to understand the experience of death and dying in a hospital emergency department. Culturally, some individuals are unprepared for death, and when death occurs in an emergency setting it can be particularly shocking.

METHODS

A phenomenological study was undertaken, based on the existential phenomenology of Merleau-Ponty; and framed by the nurse theorist Hildegard Peplau. Bereaved relatives and registered nurses gave in-depth interviews describing their experiences and the interviews were analysed using an adaptation of the work of Thomas and Pollio (2002) and Hycner (1985), consistent with Merleau-Ponty's theories.

RESULTS

The study brings new understanding of what it is like to die in an emergency setting through new understanding of what the accompanying relatives/friends of the deceased person experience, aided by new understanding of the experiences of emergency nurses.

CONCLUSIONS

A nursing model based both on the work of Peplau (Parse et al. 2000) and on the work of the nurse theorists Ruland and Moore (1998) and Zaccara et al. (2017) was devised for use in the emergency department when death occurs. It is hoped that this model will help nurses improve the care given to this group of patients and their loved ones.

Productivity of Advanced Clinical Practitioners in Emergency Medicine: A 1-year dual-centre retrospective analysis

BACKGROUND

The ACP role is relatively new in Emergency Medicine (EM) nationally (RCEM, 2017). This work sought to establish the productivity of EM ACPs within our service, to enable evidence-based workforce planning and national benchmarking of this aspect of the role.

METHODOLOGY

Data from 1st January 2018-31st December 2018 was retrospectively collected from two hospitals in the United Kingdom (UK) via electronic patient records. In addition to the number of patients seen by ACPs (attending), the number of patients who were seen by an ACP as a senior review (SR) was collected. The productivity was mapped to ACP experience, with patient acuity and disposal reported.

RESULTS

In the study period 239,951 patients were seen in the Emergency Departments (EDs) of the two study hospitals. Overall 20,442 (8.5%) patients received care from an ACP. Mean productivity was 1.03 patients per hour (attending) and 1.53 patients per hour (attending and senior review).

DISCUSSION

EM ACPs form part of the RCEM future workforce strategy to overcome some of the contemporary challenges in EM (Hassan, 2018). To our knowledge, this is the first study which has examined and reported the productivity of ACPs in UK EM.

CONCLUSION

This paper sets a national benchmark for other EDs by reporting ACP productivity and contributes to the evidence by reporting productivity in other clinician groups. The data presented may be helpful in future national workforce planning for UK EDs.