Introduction/Background/Significance
We report on emergency department (ED) use by a cohort of patients who were randomised to a regional community-based palliative care research study over a six month period, whose preferred place of care was in the community.
Aims/Objectives/Hypothesis/Goals or Problem
To describe the community-based palliative care patient’s ED use by demographics (gender, age); carer or no carer; malignant or non-malignant; reason and outcome for each presentation and to determine if there was an increase in the rate of presentations during the COVID-19 lockdown.
Approach/Methods/Procedure
Public hospital ED data (iPM) were examined, additional data were drawn from Palliative Care (ARIA) and Area Health (CAP) patient electronic records and study data held in REDCap 10.1.4. Ethics approval 2019/ETH13085. Statistical analysis was conducted using Stata 16.0.
Results/Findings/Outcomes
A total of 227 patients were randomised over a six-month period. We followed patients prospectively until end of life (n=109), admission to residential aged care (n=10), withdrawal from study (n=9) or the end of the observation period 31/1/2022 (n=99 survived). During this period, 88 patients did not attend any public EDs in the region, and 139 patients presented a total of 246 times (range n=1-6). Overall, the rate of ED presentation was 1.9 per patient/6-months, however the rate was higher during the COVID-19 lockdown compared to non-lockdown period (3.4/person/6months, and 0.99/person/6-months respectively, incidence rate ratio 3.4, 95%CI 2.59, 4.55, p<0.001).
The most common reason for presenting to ED was “COVID-19 Suspected” (18.8%); Respiratory - Shortness of Breath (9%); Pain-abdominal (7.7%) and falls-unspecified (7.3%). The majority of ED presentations resulted in an admission (n=197, 80.0% and 80.1% during lockdown and non-lockdown respectively). Patients who attended ED were younger (mean 74.6 compared to a mean of 77.7 for those not presenting to ED); male (59.7% in those presenting to ED compared to 55.5% for our whole cohort); and had a malignant diagnosis (100/139 patients). We observed that the presence of a carer did not alter the risk of ED presentation.
Discussion/Implications for practice:
Detailed examination or reasons for presentation during and outside of COVID-19 lockdown will be presented.
Conclusion:
ED presentations in our cohort of palliative care patients increased during COVID-19 stay-at-home public health orders. Understanding reasons may assist services address patient needs during any future lockdowns.